Coeliac disease. Diagnostic and therapeutic pitfalls.

Gluten-free diet (GFD) as the standard treatment for coeliac disease (CD) was discovered by Dicke. In 1989 Holmes attributed a protective role to GFD with regard to the development of malignancy in untreated CD. Gluten sensitivity is in general an asymptomatic condition. The identification of subclinical cases is becoming a major topic of current interest. Defining high-risk groups for coeliac disease is mandatory. The evaluation of small-intestine biopsies (SIB), however, is much more complicated, as was suggested in the past. Recognition of the Corazza sign and rediscovery of the endoscopic guided capsule may well be of help. Screening patients with a high-risk of CD with a minimal number of tests prior to SIB makes more and more sense. Therefore intestinal permeability tests might be helpful. GFD appears simple, but in practice it represents a challenge to patients, dietitians and physicians. Management of coeliac disease seems much more complicated, as was thought in the early 1980s.