Diagnosis of Coeliac Sprue

Overview

At the author’s department for almost three decades bioptic and differential diagnosis of malabsorptionsyndrome is made using a method elaborated and introduced by Lojda. Later the diagnosis was supplemented byimmunological examination for the presence of substances against gliadin, reticulin and endomysin in serum andquantification of lymphocytes in the epithelium. In the submitted paper the authors tried to compare the resultsof different examinations in the course of one year, to assess their significance and to recommend a suitablediagnostic algorithm. Based on the assessed results the authors assume that the number of entrobiopsies can bereduced as outlined below.The first (diagnostic) biopsy is essential and is part of the standard diagnosis lege artis. Its results may or neednot confirm the dg. of coeliac disease as the cause of malabsorption syndrome. At the same time it is useful tosupplement the bioptic examination by assessment of EMA antibodies.The second biopsy (on a gluten-free diet) may be omitted in case of previous diagnosis of coeliac disease if the patienton the gluten-free diet has no symptoms of the disease and at the same time EMA antibodies are negative. If despitethe gluten-free diet consumed for a sufficiently long time and after elimination of other etiological causes any of thementioned clinical symptoms persist and/or EMA antibodies are not negative, the authors recommend biopsy.The third biopsy (after a gluten challenge) is not essential in our view if clinical manifestations reappear andEMA are again positive. In that case it is necessary to adhere throughout life to a gluten-free diet. If after the glutenchallenge the above described changes do not occur, authors recommend biopsy to confirm a normal finding ofthe intestinal mucosa. In that case probably coeliac sprue was not involved and the diet can be more liberal. Eventhen the patient should not be completely eliminated from dispensary care. Monitoring of the clinical conditionand EMA should proceed also in future after circa one-year intervals.

Key words:
coeliac sprue, malabsorption syndrome (MAS), antibodies against smooth muscle endomysin(EMA), enterobiopsy, gluten-free diet