Celiac.com 08/01/2011 - Over the last two decades, there has been a marked increase in the prevalence of celiac disease, especially the sub-clinical celiac disease forms and non-celiac gluten sensitivity. Most people with celiac disease now present atypical or non-classical symptoms.

However, even with improved evaluation methods, clinicians may often face variable histological and clinical presentations of celiac disease, and they may be confused by diagnostic models in the current guidelines.

A team of researchers recently set out to reassess sub-clinical celiac disease and gluten sensitivity. The study team included Mohammad Rostami Nejad, Sabine Hogg- Kollars, Sauid Ishaq, Kamran Rostami

They are affiliated variously with the Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, School of Immunity and Infection, University of Birmingham, and the Dudley Group of Hospital NHS Foundation Trust, both in the UK.

Improved celiac evaluation methods, and the discovery such conditions as non-celiac gluten sensitivity have them recommending that clinicians use the term 'sub-clinical' in place of  'silent,' and 'atypical' in place of 'potential/latent,' as a way to better understand clinical atypical celiac disease. 

Although terminologies like 'latent,' 'silent' and 'potential' do reflect certain observable aspects of clinical and pathological celiac disease, they also cause some confusion between clinicians and patients, in part because the definitions are still somewhat vague and subjective.

The researchers point out that 'silent' celiac disease is not actually silent after all. Rather, patients show signs of celiac disease with no significant symptoms. Meanwhile, the terms 'potential' and 'latent' are defined differently across numerous studies.

The researchers point out the widening spectrum of gluten related disorders, and note that these common systemic disorders have numerous causes with a variety of symptoms and complications inside and outside the small bowel.

They conclude that the body of evidence supports decreasing the treatment threshold in people with atypical celiac disease and gluten sensitivity. Since long-term complications of sub-clinical celiac disease remain unknown, they say, it is appropriate to diagnose such patients as early as possible, and to treat them with a gluten-free diet.

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