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. Although IgA anti-endomysial antibody is specific for CD, tests are not sufficiently sensitive for use alone.
Results are less reliable in laboratories that perform only a few tests.
It is important to include an IgG anti-gliadin antibody screen to detect those coeliacs with selective IgA deficiency. Despite the sensitivity and specificity of screening, an endoscopic jejunal biopsy is required to confirm the diagnosis. It is essential that the biopsy is performed while the patient is on a gluten containing diet. Withdrawal of gluten from the diet allows the villi to recover and may delay diagnosis as the patient will have to undergo a gluten challenge and repeat biopsy. Once coeliac disease is confirmed, the patient is referred to a state registered dietitian who will advise on diet management.