Challenges and Controversies in the Diagnosis of Celiac Disease

Celiac disease (CD) is world wide in distribution cutting across all sections of society. There is a high incidence reported from India. CD is a permanent disorder; a T cell mediated enteropathy due to allergy towards the gliadin fraction of gluten in a genetically susceptible individual. Classical presentations of the disorder are now relatively less common and there are more and more emerging disorders both gastrointestinal and non-gastrointestinal that have been linked to CD. In fact CD has protean manifestations and must be always kept in mind in differential diagnosis of several common presentations in pediatric practice. Diagnosis of the condition is relatively easy once it is suspected. Serological tests are accurate, easily available and are adjuncts to diagnosis especially in our country where minor histological changes are often present in the gut. The diagnosis of CD rests on the biopsy and improvement on a gluten free diet. At present screening is recommended by tissue transglutaminase antibody (human antigen) in suspected or in high risk individuals and confirmed by duodenal biopsy. As celiac disease histology is very variable standards for our country must be evaluated further. This article focuses on various aspects of diagnosis of celiac disease and some of the controversies surrounding it.