He says that celiac disease is much more than just a GI disease, citing DH, too, and gluten ataxia, and many other cases. And he notes the nervous system has poor regenerative ability.
He cites the pyramid:
The tip of the iceberg is Active celiac disease - signs and symptoms, check; genetic, check; serology, positive; mucosal damage.
There is Potential - relatives and patients who are at high risk.
And with Latent celiac disease you have normal mucosa, but you have the genetics and presence of antibodies.
Silent celiac disease - with abnormal mucosa and no symptoms.
We need to treat the disease, not the mucosa, he says.
So in the case of suspecting celiac disease in the face of negative testing, Dr Hasan recommends doing a genetic study. If positive, go on a trial of gluten-free diet.
He says 20% of patients w/ DH, have normal mucosa.