Autism Studies and Related Medical Conditions, January 2009 - TACA

clinical presentations make celiac disease often difficult to diagnose, and the ubiquitous
presence of prolamins in the Western diet make treatment challenging.
162. Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac
disease: an evolving spectrum. Gastroenterology 2001 120(3):636-51. PMID:
11179241
"Celiac disease (CD) is a syndrome characterized by damage of the small intestinal
mucosa caused by the gliadin fraction of wheat gluten and similar alcohol-soluble
proteins (prolamines) of barley and rye in genetically susceptible subjects. The presence
of gluten in these subjects leads to self-perpetuating mucosal damage, whereas
elimination of gluten results in full mucosal recovery. The clinical manifestations of CD
are protean in nature and vary markedly with the age of the patient, the duration and
extent of disease, and the presence of extraintestinal pathologic conditions. In addition
to the classical gastrointestinal form, a variety of other clinical manifestations of the
disease have been described, including atypical and asymptomatic forms. Therefore,
diagnosis of CD is extremely challenging and relies on a sensitive and specific algorithm
that allows the identification of different manifestations of the disease. Serologic tests
developed in the last decade provide a noninvasive tool to screen both individuals at
risk for the disease and the general population…"
163. Catassi C, Fabiani E. The spectrum of coeliac disease in children. Baillieres Clin
Gastroenterol. 1997 Sep;11(3):485-507. PMID: 9448912
"Coeliac disease is the life-long intolerance to dietary gluten, usually characterized by
severe damage to the small-intestinal mucosa. The widespread use of sensitive
diagnostic tools, such as the serum anti-gliadin and the anti-endomysial antibodies, has
shown not only that coeliac disease is one of the commonest disorders in Western
countries but also that this condition is characterized by a higher degree of clinical
variability than previously thought (typical, atypical and silent forms). The existence of a
latent-potential coeliac disease and even a gluten-sensitive disease with immunological
activation of an otherwise normal small-intestinal mucosa has recently been postulated.
An increased prevalence of coeliac disease in a number of other disorders has also been
reported in both children and adults. The reasons for such a wide clinical heterogeneity
are still poorly understood but are likely to depend on both genetic and environmental
factors. Further investigations are required to evaluate the impact of undiagnosed,
clinically milder forms of coeliac disease on the well-being of the population."
164. Murray JA. The widening spectrum of celiac disease. Am J Clin Nutr. 1999
Mar;69(3):354-65. http://www.ajcn.org/cgi/reprint/69/3/354.pdf
165. Sollid LM, Gray GM. A role for bacteria in celiac disease? Am J Gastroenterol. 2004
May;99(5):905-6. {Comment on: Am J Gastroenterol. 2004 May;99(5):894-904.} PMID:
15128358
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