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Subclinical celiac disease and gluten sensitivity.

Rostami Nejad M, Hogg-Kollars S, Ishaq S, Rostami K - Gastroenterol Hepatol Bed Bench (2011)

Bottom Line: Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them.In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD.The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.

View Article: PubMed Central - PubMed

Affiliation: Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT
Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.

No MeSH data available.


Related in: MedlinePlus

Celiac and non-celiac gluten sensitivity* Suclinical: previously known as silent and atypical as known under latent and potential CD
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Figure 0001: Celiac and non-celiac gluten sensitivity* Suclinical: previously known as silent and atypical as known under latent and potential CD

Mentions: Subclinical or so called silent CD cases are being detected in increasing numbers because of raised awareness of the disease. Presentations with atypical symptoms are the dominant form of disease manifestation and these comprise the sole and main part of the celiac iceberg (16). Whether they have positive serology with negative biopsy or increased γδ T Cells receptors with symptoms compatible with CD they could be classified as atypical CD. We are moving towards a lower threshold in implementing a gluten free diet (GFD). Villous atrophy is not mandatory any longer to qualify a patient for GFD. In fact a large number of patients present with non-celiac gluten sensitivity with completely normal biopsy and negative serology. They also seem to benefit from a GFD. In such circumstances there is a need to re-define the terminologies according to the modified treatment strategy in gluten related disorders. The main strategy for treatment should target symptomatic typical or atypical patients, and not asymptomatic cases. We propose a simplified classification by dividing and replacing previous terminology to typical, atypical and subclinical instead of silent/latent and potential. (See Figure 1).


Subclinical celiac disease and gluten sensitivity.

Rostami Nejad M, Hogg-Kollars S, Ishaq S, Rostami K - Gastroenterol Hepatol Bed Bench (2011)

Celiac and non-celiac gluten sensitivity* Suclinical: previously known as silent and atypical as known under latent and potential CD
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4017418&req=5

Figure 0001: Celiac and non-celiac gluten sensitivity* Suclinical: previously known as silent and atypical as known under latent and potential CD
Mentions: Subclinical or so called silent CD cases are being detected in increasing numbers because of raised awareness of the disease. Presentations with atypical symptoms are the dominant form of disease manifestation and these comprise the sole and main part of the celiac iceberg (16). Whether they have positive serology with negative biopsy or increased γδ T Cells receptors with symptoms compatible with CD they could be classified as atypical CD. We are moving towards a lower threshold in implementing a gluten free diet (GFD). Villous atrophy is not mandatory any longer to qualify a patient for GFD. In fact a large number of patients present with non-celiac gluten sensitivity with completely normal biopsy and negative serology. They also seem to benefit from a GFD. In such circumstances there is a need to re-define the terminologies according to the modified treatment strategy in gluten related disorders. The main strategy for treatment should target symptomatic typical or atypical patients, and not asymptomatic cases. We propose a simplified classification by dividing and replacing previous terminology to typical, atypical and subclinical instead of silent/latent and potential. (See Figure 1).

Bottom Line: Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them.In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD.The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.

View Article: PubMed Central - PubMed

Affiliation: Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT
Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.

No MeSH data available.


Related in: MedlinePlus