Diagnosing celiac disease: how important is the biopsy?

摘要

Celiac disease (CD) is a common condition, with an estimated prevalence of 1% in Western populations. CD is defined as a permanent sensitivity to wheat and related proteins found in barley and rye that occurs in genetically predisposed individuals. It manifests as an immune-mediated enteropathy that shows characteristic changes on intestinal histology. With few exceptions, individuals with CD have markers for the HLA-DQ2 genotype and/or -DQ8 genotype and produce antibodies to tissue transglutaminase (TG2) and/or endomysium (EMA). The changes seen on intestinal histology are mediated by immune mechanisms involving both the innate and adaptive arms of the immune system, and progress from an increase in intraepithelial lymphocytes to crypt hyperplasia and finally progressive villous blunting.