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Permanent gluten sensitive enteropathy - genetically determined
mucosal lesions (atrophy) on upper GI Bx - cell mediated to gliadin (wheat, rye, barley)
present in 1 in 100 people in UK but only 10-15% of these are clinically diagnosed.
98% respond to gluten free diet - amt of gluten tolerated varies between individuals
//bloods// - NICE
transglutaminase IgA (sens >90%, spec >97%) - use first for screen (need to be eating gluten at >1 meal a day for >6/52)
gold standard - endomysial antibodies (sens >90%, spec >97%)
(elevated IgA to gliadin - it is advised not to use this test for diagnosis (sens 75-95%, spec 80-95%))
anti-casein Abs also may be found
all Abs tests should be confirmed with jejunal Bx
 
''Mx''
diet
check for other conditions 
Iron and folate deficiency anaemia
failure to respond - lactose intolerance / Zn Cu pancreatic deficiency or malignancy
long term risk untreated - GI lymphoma

Note ...
Gluten free means avoid ...
wheat - bread, pasta, pastry
barley - beer (whiskey is made with barley but distilling removes protein so OK for coeliac)
rye
oats - some pts can tolerate

OK are ... rice, potatoes, corn (maize)

''Associated conditions'' (consider testing for (2009 NICE) ...)
dermatitis herpetiformis (a vesicular, pruritic skin eruption)
autoimmune disorders (type 1 diabetes mellitus, autoimmune hepatitis, autoimmune thyroid). 
Family members - strongly associated with HLA-DQ2 (95% of patients), HLA-B8 (80%), HLA-DR3 and DR7

''Signs/symptoms''
    Chronic or intermittent diarrhoea
    Failure to thrive or faltering growth (in children)
    Persistent or unexplained gastrointestinal symptoms including nausea and vomiting
    Prolonged fatigue ('tired all the time')
    Recurrent abdominal pain, cramping or distension
    Sudden or unexpected weight loss
    Unexplained iron-deficiency anaemia, or other unspecified anaemia