Advances in diagnosis and management of celiac disease

Gastroenterology. 2015 May;148(6):1175-86. doi: 10.1053/j.gastro.2015.01.044. Epub 2015 Feb 3.


Celiac disease is an autoimmune disorder that is induced by dietary gluten in genetically predisposed individuals. It has a prevalence of approximately 1% in many populations worldwide. New diagnoses have increased substantially, owing to increased awareness, better diagnostic tools, and probable real increases in incidence. The breadth of recognized clinical presentations continues to expand, making the disorder highly relevant to all physicians. Newer diagnostic tools, including serologic tests for antibodies against tissue transglutaminase and deamidated gliadin peptide, greatly facilitate diagnosis. Tests for celiac-permissive HLA-DQ2 and HLA-DQ8 molecules are useful in defined clinical situations. Celiac disease is diagnosed by histopathologic examination of duodenal biopsy specimens. However, according to recent controversial guidelines, a diagnosis can be made without a biopsy in certain circumstances, especially in children. Symptoms, mortality, and risk for malignancy each can be reduced by adherence to a gluten-free diet. This treatment is a challenge, however, because the diet is expensive, socially isolating, and not always effective in controlling symptoms or intestinal damage. Hence, there is increasing interest in developing nondietary therapies.

Keywords: Autoimmune; Cereal; Diet; Enteritis; Enteropathy; Gluten; Gluten-Free Diet; Lymphoma; Malabsorption; Nutritional Deficiency; Refractory; Serology; Villous Atrophy; Wheat.

Publication types

  • Review

MeSH terms

  • Animals
  • Autoantibodies / blood
  • Biomarkers / blood
  • Biopsy
  • Celiac Disease / diagnosis*
  • Celiac Disease / diet therapy*
  • Celiac Disease / genetics
  • Celiac Disease / immunology
  • Diet, Gluten-Free*
  • Genetic Markers
  • Genetic Predisposition to Disease
  • Genetic Testing*
  • HLA-DQ Antigens / genetics
  • HLA-DQ Antigens / immunology
  • Humans
  • Phenotype
  • Predictive Value of Tests
  • Risk Factors
  • Serologic Tests*
  • Treatment Outcome


  • Autoantibodies
  • Biomarkers
  • Genetic Markers
  • HLA-DQ Antigens
  • HLA-DQ2 antigen
  • HLA-DQ8 antigen