Coeliac disease: An under-recognized nutritional disorder

Celiac disease (CD) is an immune - mediated enteropathy caused by ingestion of gluten present in wheat, barley, and rye in genetically susceptible individuals. It was considered to be a disease of childhood, but now it is reported with an increasing frequency. Classically, it present with intestinal symptoms such as diarrhea. However, in recent studies more patients are diagnosed with extra-intestinal manifestations. A trend towards more extra-intestinal manifestations and diagnosis at later age reported from several countries. In developing countries, CD is a diagnostic dilemma because the histological changes may not be pathognomonic of the disease and several other common conditions such as persistent enteric infections, parasitic infestation, small bowel bacterial overgrowth or tropical sprue have similar mucosal abnormalities. Furthermore, interpretation of mucosal histology in the presence of severe malnutrition where similar changes may be seen is difficult. A highly sensitive and specific test as adjuncts to histology is required in diagnosing celiac disease. Delay in diagnosis may also be there mainly because of lack of awareness about this condition because the symptoms may have been attributed to many other more frequently occurring conditions such as gastrointestinal infections, infestations, and nutritional deficiencies. However, untreated CD may lead to several complications, some of which may be irreversible, so early diagnosis and prompt institution of gluten free diet is important.