A clinicopathological approach to the diagnosis of coeliac disease

Coeliac disease is defined as a small bowel enteropathy due to immune mediated damage on exposure to gluten in the diet, occurring in those with a genetic predisposition to this condition. Previously considered rare, the prevalence of coeliac disease is increasing due to a genuine rise in incidence and also better detection. The diagnosis of coeliac disease involves many disciplines, presentation is varied and if the diagnosis is delayed there is a risk of poor quality of life and a small increase in malignancy. Serology is a first line test, followed by confirmatory small intestinal biopsy. This review discusses the clinicopathological approach to diagnosis, through serology and biopsy and discusses complications which occur in some individuals, namely refractory coeliac disease and dermatitis herpetiformis. The entity of non-coeliac gluten sensitivity is also entering the spectrum of coeliac diagnosis and may lead to an extension of the diagnostic parameters of coeliac disease.