Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders
Abstract
:1. Introduction
2. Coeliac Disease
2.1. Clinical Issues Leading to Misdiagnoses of CD
2.1.1. Diagnostic Errors Related to Incorrect Timing of a Gluten-Free Diet
2.1.2. Serology-Related Diagnostic Errors
2.2. Endoscopy/Histology-Related Diagnostic Mistakes
2.3. Diagnostic Errors Related to HLA Typing
3. Non-Responsive Coeliac Disease
4. Dermatitis Herpetiformis
5. Wheat Allergy
5.1. IgE-Mediated Wheat Allergy
5.2. Non-IgE-Mediated Wheat Allergy
6. Non-Coeliac Gluten Sensitivity
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Coeliac Disease | Dermatitis Herpetiformis | Gluten Ataxia | Wheat Allergy | NCGS | |
---|---|---|---|---|---|
Prevalence in the general population |
| 30–75 per 100,000 |
| Prevalence assessed by OFD still unknown |
|
Pathogenesis |
| Role of TG3 enzyme | AGA cross-react with epitopes on Purkinje cells |
|
|
Genetics | HLA-DQ2 and DQ8 restricted | HLA-DQ2 and DQ8 restricted | Not HLA restricted | Not HLA restricted | Not HLA restricted |
Serum antibodies |
|
|
| - positive serum IgE to wheat |
|
Small bowel histology |
| Increased IEL in almost 100% but frank VA in only 70%–75% of patients | Duodenal VA in up to 40% patients | Normal duodenal histology | Normal duodenal architecture |
Clinical picture |
| Itchy blistering rash involving elbows, extensor surfaces of forearms, knees and buttocks | - gait and lower limb ataxia ± other GI or extra-GI symptoms | Intestinal and extra-intestinal symptoms within minutes to 1–3 h after exposure to wheat | Intestinal and extra-intestinal symptoms |
Risk of complications |
| Not increased | Progression of neurological dysfunction | Increased (anaphylaxis) | Unknown |
Morbidity | Increased | Not increased | Increased | Increased | Unknown |
Mortality | Increased | Not increased | Increased | Increased | Unknown |
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Schiepatti, A.; Savioli, J.; Vernero, M.; Borrelli de Andreis, F.; Perfetti, L.; Meriggi, A.; Biagi, F. Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders. Nutrients 2020, 12, 1711. https://doi.org/10.3390/nu12061711
Schiepatti A, Savioli J, Vernero M, Borrelli de Andreis F, Perfetti L, Meriggi A, Biagi F. Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders. Nutrients. 2020; 12(6):1711. https://doi.org/10.3390/nu12061711
Chicago/Turabian StyleSchiepatti, Annalisa, Jessica Savioli, Marta Vernero, Federica Borrelli de Andreis, Luca Perfetti, Antonio Meriggi, and Federico Biagi. 2020. "Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders" Nutrients 12, no. 6: 1711. https://doi.org/10.3390/nu12061711
APA StyleSchiepatti, A., Savioli, J., Vernero, M., Borrelli de Andreis, F., Perfetti, L., Meriggi, A., & Biagi, F. (2020). Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders. Nutrients, 12(6), 1711. https://doi.org/10.3390/nu12061711