However, it is important to identify patients with milder disease as they too are also at risk of compromising their health. Patients will exhibit the effects of nutritional deficiencies which in turn may lead to metabolic disturbance. In particular, villous atrophy leads to reduced calcium absorption and coeliac patients have low bone mineral density. In females this may be compounded by the effects of early menopause. Osteoporosis and osteopenia are common features of untreated coeliac disease.
Early diagnosis is essential as peak bone mineral density is reached in early adulthood.
Bone mineralisation improves on a gluten-free diet. As noted earlier, exposure to gluten stimulates lymphocyte infiltration of the small bowel mucosa. Other malignancies that occur more frequently in untreated coeliacs include oesophageal and pharyngeal lymphomas and small bowel adenocarcinomas. Diagnosis Adult presentation of coeliac disease in particular can be very vague. Fortunately, antibody screening is now available to screen patients prior to performing a small bowel biopsy.