Advertisement

Celiac Disease pp 107-122 | Cite as

Diagnosis of Celiac Disease

  • Anna Tavakkoli
  • Benjamin LebwohlEmail author
Chapter
Part of the Clinical Gastroenterology book series (CG)

Abstract

Patients with celiac disease (CD) can have a variety of different presenting symptoms, ranging from features of intestinal malabsorption to nonclassical features, such as elevated transaminases or osteoporosis, to a silent form of the disease in which villous atrophy is discovered in asymptomatic patients [1, 2]. The diagnosis of CD is currently made through a combination of serological, genetic, and endoscopic testing. The aim of this chapter is to help identify the appropriate patient to test for CD, to review the different serological tests available for the diagnosis of CD, and to discuss the role of genetic testing and endoscopy in the diagnosis of this disease. The diagnosis of CD in children will also be reviewed.

Keywords

Irritable Bowel Syndrome Celiac Disease Down Syndrome Villous Atrophy Celiac Disease Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731–43. PubMed PMID: 17960014.PubMedCrossRefGoogle Scholar
  2. 2.
    Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology. 2006;131(6):1981–2002. PubMed PMID: 17087937.PubMedCrossRefGoogle Scholar
  3. 3.
    Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107(10):1538–44. quiz 7, 45. PubMed PMID: 22850429.PubMedCrossRefGoogle Scholar
  4. 4.
    Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton 3rd LJ. Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001. Clin Gastroenterol Hepatol. 2003;1(1):19–27. PubMed PMID: 15017513.PubMedCrossRefGoogle Scholar
  5. 5.
    Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, et al. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med. 2010;42(7):530–8. PubMed PMID: 20868314.PubMedCrossRefGoogle Scholar
  6. 6.
    Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43–52. PubMed PMID: 22345659. Pubmed Central PMCID: 3440559.PubMedCrossRefGoogle Scholar
  7. 7.
    Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med. 2006;119(4):355. e9–14. PubMed PMID: 16564784.PubMedGoogle Scholar
  8. 8.
    Sainsbury A, Sanders DS, Ford AC. Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: a Meta-analysis. Clin Gastroenter Hepatol. 2013;11:359–65. PubMed PMID: 23246645.CrossRefGoogle Scholar
  9. 9.
    Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169(7):651–8. PMID 19364994.PubMedCrossRefGoogle Scholar
  10. 10.
    Admou B, Essaadouni L, Krati K, Zaher K, Sbihi M, Chabaa L, et al. Atypical celiac disease: from recognizing to managing. Gastroenterol Res Pract. 2012;2012:637187. PubMed PMID: 22811701. Pubmed Central PMCID: 3395124.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006;8(5):383–9. PubMed PMID: 16968605.PubMedCrossRefGoogle Scholar
  12. 12.
    Freeman HJ. Risk factors in familial forms of celiac disease. World J Gastroenterol. 2010;16(15):1828–31. PubMed PMID: 20397258. Pubmed Central PMCID: 2856821.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Dogan Y, Yildirmaz S, Ozercan IH. Prevalence of celiac disease among first-degree relatives of patients with celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(2):205–8. PubMed PMID: 22241509.PubMedCrossRefGoogle Scholar
  14. 14.
    Volta U, Rodrigo L, Granito A, Petrolini N, Muratori P, Muratori L, et al. Celiac disease in autoimmune cholestatic liver disorders. Am J Gastroenterol. 2002;97(10):2609–13. PubMed PMID: 12385447.PubMedCrossRefGoogle Scholar
  15. 15.
    Aktay AN, Lee PC, Kumar V, Parton E, Wyatt DT, Werlin SL. The prevalence and clinical characteristics of celiac disease in juvenile diabetes in Wisconsin. J Pediatr Gastroenterol Nutr. 2001;33(4):462–5. PubMed PMID: 11698764.PubMedCrossRefGoogle Scholar
  16. 16.
    Cronin CC, Feighery A, Ferriss JB, Liddy C, Shanahan F, Feighery C. High prevalence of celiac disease among patients with insulin-dependent (type 1) diabetes mellitus. Am J Gastroenterol. 1997;92(12):2210–2. PubMed PMID: 9399754.PubMedGoogle Scholar
  17. 17.
    Cuoco L, Certo M, Jorizzo RA, De Vitis I, Tursi A, Papa A, et al. Prevalence and early diagnosis of coeliac disease in autoimmune thyroid disorders. Ital J Gastroenterol Hepatol. 1999;31(4):283–7. PubMed PMID: 10425571.PubMedGoogle Scholar
  18. 18.
    Aggarwal S, Lebwohl B, Green PH. Screening for celiac disease in average-risk and high-risk populations. Therap Adv Gastroenterol. 2012;5(1):37–47. PubMed PMID: 22282707. Pubmed Central PMCID: 3263981.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    National Institutes of Health Consensus Development Conference Statement on Celiac Disease, June 28–30, 2004. Gastroenterology. 2005;128(4 Suppl 1):S1–9. PubMed PMID: 15825115.Google Scholar
  20. 20.
    Lebwohl B, Rubio-Tapia A, Assiri A, Newland C, Guandalini S. Diagnosis of celiac disease. Gastrointest Endosc Clin N Am. 2012;22(4):661–77. PubMed PMID: 23083985.PubMedCrossRefGoogle Scholar
  21. 21.
    Hershcovici T, Leshno M, Goldin E, Shamir R, Israeli E. Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free diet. Aliment Pharmacol Ther. 2010;31(8):901–10. PubMed PMID: 20096017.PubMedGoogle Scholar
  22. 22.
    Leffler DA, Schuppan D. Update on serologic testing in celiac disease. Am J Gastroenterol. 2010;105(12):2520–4. PubMed PMID: 21131921.PubMedCrossRefGoogle Scholar
  23. 23.
    O’Farrelly C, Kelly J, Hekkens W, Bradley B, Thompson A, Feighery C, et al. Alpha gliadin antibody levels: a serological test for coeliac disease. Br Med J. 1983;286(6383):2007–10. PubMed PMID: 6409205. Pubmed Central PMCID: 1548488.CrossRefGoogle Scholar
  24. 24.
    Rostom A, Dube C, Cranney A, Saloojee N, Sy R, Garritty C, et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology. 2005;128(4 Suppl 1):S38–46. PubMed PMID: 15825125.PubMedCrossRefGoogle Scholar
  25. 25.
    Hill ID. What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? Gastroenterology. 2005;128(4 Suppl 1):S25–32. PubMed PMID: 15825123.PubMedCrossRefGoogle Scholar
  26. 26.
    Naiyer AJ, Hernandez L, Ciaccio EJ, Papadakis K, Manavalan JS, Bhagat G, et al. Comparison of commercially available serologic kits for the detection of celiac disease. J Clin Gastroenterol. 2009;43(3):225–32. PubMed PMID: 18724250.PubMedCrossRefGoogle Scholar
  27. 27.
    Schuppan D, Junker Y, Barisani D. Celiac disease: from pathogenesis to novel therapies. Gastroenterology. 2009;137(6):1912–33. PubMed PMID: 19766641.PubMedCrossRefGoogle Scholar
  28. 28.
    Prince HE. Evaluation of the INOVA diagnostics enzyme-linked immunosorbent assay kits for measuring serum immunoglobulin G (IgG) and IgA to deamidated gliadin peptides. Clin Vaccine Immunol. 2006;13(1):150–1. PubMed PMID: 16426013. Pubmed Central PMCID: 1356631.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Volta U, Granito A, Parisi C, Fabbri A, Fiorini E, Piscaglia M, et al. Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. J Clin Gastroenterol. 2010;44(3):186–90. PubMed PMID: 20042872.PubMedCrossRefGoogle Scholar
  30. 30.
    Rostami K, Kerckhaert J, Tiemessen R, von Blomberg BM, Meijer JW, Mulder CJ. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol. 1999;94(4):888–94. PubMed PMID: 10201452.PubMedCrossRefGoogle Scholar
  31. 31.
    Fasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med. 2012;367(25):2419–26. PubMed PMID: 23252527.PubMedCrossRefGoogle Scholar
  32. 32.
    Tesei N, Sugai E, Vazquez H, Smecuol E, Niveloni S, Mazure R, et al. Antibodies to human recombinant tissue transglutaminase may detect coeliac disease patients undiagnosed by endomysial antibodies. Aliment Pharmacol Ther. 2003;17(11):1415–23. PubMed PMID: 12786636.PubMedCrossRefGoogle Scholar
  33. 33.
    Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Riecken EO, et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med. 1997;3(7):797–801. PubMed PMID: 9212111.PubMedCrossRefGoogle Scholar
  34. 34.
    Zintzaras E, Germenis AE. Performance of antibodies against tissue transglutaminase for the diagnosis of celiac disease: meta-analysis. Clin Vaccine Immunol. 2006;13(2):187–92. PubMed PMID: 16467324. Pubmed Central PMCID: 1391934.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Raivio T, Korponay-Szabo I, Collin P, Laurila K, Huhtala H, Kaartinen T, et al. Performance of a new rapid whole blood coeliac test in adult patients with low prevalence of endomysial antibodies. Dig Liver Dis. 2007;39(12):1057–63. PubMed PMID: 17983878.PubMedCrossRefGoogle Scholar
  36. 36.
    Alarida K, Harown J, Ahmaida A, Marinelli L, Venturini C, Kodermaz G, et al. Coeliac disease in Libyan children: a screening study based on the rapid determination of anti-transglutaminase antibodies. Dig Liver Dis. 2011;43(9):688–91. PubMed PMID: 21310672.PubMedCrossRefGoogle Scholar
  37. 37.
    Raivio T, Kaukinen K, Nemes E, Laurila K, Collin P, Kovacs JB, et al. Self transglutaminase-based rapid coeliac disease antibody detection by a lateral flow method. Aliment Pharmacol Ther. 2006;24(1):147–54. PubMed PMID: 16803613.PubMedCrossRefGoogle Scholar
  38. 38.
    Yel L. Selective IgA deficiency. J Clin Immunol. 2010;30(1):10–6. PubMed PMID: 20101521. Pubmed Central PMCID: 2821513.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Cunningham-Rundles C. Physiology of IgA and IgA deficiency. J Clin Immunol. 2001;21(5):303–9. PubMed PMID: 11720003.PubMedCrossRefGoogle Scholar
  40. 40.
    Cataldo F, Marino V, Ventura A, Bottaro G, Corazza GR. Prevalence and clinical features of selective immunoglobulin A deficiency in coeliac disease: an Italian multicentre study. Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP) and “Club del Tenue” Working Groups on Coeliac Disease. Gut. 1998;42(3):362–5. PubMed PMID: 9577342. Pubmed Central PMCID: 1727042.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Chow MA, Lebwohl B, Reilly NR, Green PH. Immunoglobulin a deficiency in celiac disease. J Clin Gastroenterol. 2012;46(10):850–4. PubMed PMID: 22476042.PubMedCrossRefGoogle Scholar
  42. 42.
    Dahlbom I, Olsson M, Forooz NK, Sjoholm AG, Truedsson L, Hansson T. Immunoglobulin G (IgG) anti-tissue transglutaminase antibodies used as markers for IgA-deficient celiac disease patients. Clin Diagn Lab Immunol. 2005;12(2):254–8. PubMed PMID: 15699419. Pubmed Central PMCID: 549312.PubMedCentralPubMedGoogle Scholar
  43. 43.
    Sinclair D, Saas M, Turk A, Goble M, Kerr D. Do we need to measure total serum IgA to exclude IgA deficiency in coeliac disease? J Clin Pathol. 2006;59(7):736–9. PubMed PMID: 16489174. Pubmed Central PMCID: 1860425.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Sollid LM. Molecular basis of celiac disease. Annu Rev Immunol. 2000;18:53–81. PubMed PMID: 10837052.PubMedCrossRefGoogle Scholar
  45. 45.
    Hadithi M, von Blomberg BM, Crusius JB, Bloemena E, Kostense PJ, Meijer JW, et al. Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease. Ann Intern Med. 2007;147(5):294–302. PubMed PMID: 17785484.PubMedCrossRefGoogle Scholar
  46. 46.
    Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11(10):1185–94. PubMed PMID: 10524652.PubMedCrossRefGoogle Scholar
  47. 47.
    Rubin CE, Brandborg LL, Phelps PC, Taylor Jr HC. Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. Gastroenterology. 1960;38:28–49. PubMed PMID: 14439871.PubMedGoogle Scholar
  48. 48.
    Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology. 1992;102(1):330–54.PubMedGoogle Scholar
  49. 49.
    Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol. 1995;9(2):273–93. PubMed PMID: 7549028.PubMedCrossRefGoogle Scholar
  50. 50.
    Ferguson A, Arranz E, O’Mahony S. Clinical and pathological spectrum of coeliac disease–active, silent, latent, potential. Gut. 1993;34(2):150–1. PubMed PMID: 8432463. Pubmed Central PMCID: 1373959.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Shah VH, Rotterdam H, Kotler DP, Fasano A, Green PH. All that scallops is not celiac disease. Gastrointest Endosc. 2000;51(6):717–20. PubMed PMID: 10840307.PubMedCrossRefGoogle Scholar
  52. 52.
    Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol. 2001;96(7):2126–8. PubMed PMID: 11467643.PubMedCrossRefGoogle Scholar
  53. 53.
    Harewood GC, Holub JL, Lieberman DA. Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database. Am J Gastroenterol. 2004;99(9):1790–4. PubMed PMID: 15330920.PubMedCrossRefGoogle Scholar
  54. 54.
    Lebwohl B, Tennyson CA, Holub JL, Lieberman DA, Neugut AI, Green PH. Sex and racial disparities in duodenal biopsy to evaluate for celiac disease. Gastrointest Endosc. 2012;76(4):779–85. PubMed PMID: 22732871. Pubmed Central PMCID: 3445758.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163(3):286–92. PubMed PMID: 12578508.PubMedCrossRefGoogle Scholar
  56. 56.
    Mukherjee R, Egbuna I, Brar P, Hernandez L, McMahon DJ, Shane EJ, et al. Celiac disease: similar presentations in the elderly and young adults. Dig Dis Sci. 2010;55(11):3147–53. PubMed PMID: 20165980.PubMedCrossRefGoogle Scholar
  57. 57.
    Kurien M, Evans KE, Hopper AD, Hale MF, Cross SS, Sanders DS. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site? Gastrointest Endosc. 2012;75(6):1190–6. PubMed PMID: 22624810.PubMedCrossRefGoogle Scholar
  58. 58.
    Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, et al. A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease. Am J Gastroenterol. 2011;106(10):1837–42. PubMed PMID: 21606978.PubMedCrossRefGoogle Scholar
  59. 59.
    Gonzalez S, Gupta A, Cheng J, Tennyson C, Lewis SK, Bhagat G, et al. Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease. Gastrointest Endosc. 2010;72(4):758–65. PubMed PMID: 20883853.PubMedCrossRefGoogle Scholar
  60. 60.
    Hopper AD, Cross SS, Sanders DS. Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate? Endoscopy. 2008;40(3):219–24. PubMed PMID: 18058655.PubMedCrossRefGoogle Scholar
  61. 61.
    Pais WP, Duerksen DR, Pettigrew NM, Bernstein CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67(7):1082–7. PubMed PMID: 18308317.PubMedCrossRefGoogle Scholar
  62. 62.
    Lebwohl B, Kapel RC, Neugut AI, Green PH, Genta RM. Adherence to biopsy guidelines increases celiac disease diagnosis. Gastrointest Endosc. 2011;74(1):103–9. PubMed PMID: 21601201.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Arguelles-Grande C, Tennyson CA, Lewis SK, Green PH, Bhagat G. Variability in small bowel histopathology reporting between different pathology practice settings: impact on the diagnosis of coeliac disease. J Clin Pathol. 2012;65(3):242–7. PubMed PMID: 22081783.PubMedCrossRefGoogle Scholar
  64. 64.
    Di Sabatino A, Corazza GR. Nonceliac gluten sensitivity: sense or sensibility? Ann Intern Med. 2012;156(4):309–11. PubMed PMID: 22351716.PubMedCrossRefGoogle Scholar
  65. 65.
    Rubio-Tapia A, Rahim MW, See JA, Lahr BD, Wu TT, Murray JA. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am J Gastroenterol. 2010;105(6):1412–20. PubMed PMID: 20145607. Pubmed Central PMCID: 2881171.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    Iltanen S, Holm K, Partanen J, Laippala P, Maki M. Increased density of jejunal gammadelta + T cells in patients having normal mucosa – marker of operative autoimmune mechanisms? Autoimmunity. 1999;29(3):179–87. PubMed PMID: 10433098.PubMedCrossRefGoogle Scholar
  67. 67.
    Tuire I, Marja-Leena L, Teea S, Katri H, Jukka P, Paivi S, et al. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am J Gastroenterol. 2012;107(10):1563–9. PubMed PMID: 22825364.PubMedCrossRefGoogle Scholar
  68. 68.
    Leffler D, Schuppan D, Pallav K, Najarian R, Goldsmith JD, Hansen J, et al. Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease. Gut. 2013;62:996–1004. PubMed PMID: 22619366. Pubmed Central PMCID: 3525791.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005;40(1):1–19. PubMed PMID: 15625418.PubMedCrossRefGoogle Scholar
  70. 70.
    Carlsson A, Axelsson I, Borulf S, Bredberg A, Forslund M, Lindberg B, et al. Prevalence of IgA-antigliadin antibodies and IgA-antiendomysium antibodies related to celiac disease in children with Down syndrome. Pediatrics. 1998;101(2):272–5. PubMed PMID: 9445503.PubMedCrossRefGoogle Scholar
  71. 71.
    Barbato M, Maiella G, Di Camillo C, Guida S, Valitutti F, Lastrucci G, et al. The anti-deamidated gliadin peptide antibodies unmask celiac disease in small children with chronic diarrhoea. Dig Liver Dis. 2011;43(6):465–9. PubMed PMID: 21257356.PubMedCrossRefGoogle Scholar
  72. 72.
    Monzani A, Rapa A, Fonio P, Tognato E, Panigati L, Oderda G. Use of deamidated gliadin peptide antibodies to monitor diet compliance in childhood celiac disease. J Pediatr Gastroenterol Nutr. 2011;53(1):55–60. PubMed PMID: 21694536.PubMedCrossRefGoogle Scholar
  73. 73.
    Mubarak A, Wolters VM, Gerritsen SA, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr. 2011;52(5):554–7. PubMed PMID: 21240025.PubMedCrossRefGoogle Scholar
  74. 74.
    Barker CC, Mitton C, Jevon G, Mock T. Can tissue transglutaminase antibody titers replace small-bowel biopsy to diagnose celiac disease in select pediatric populations? Pediatrics. 2005;115(5):1341–6. PubMed PMID: 15867045.PubMedCrossRefGoogle Scholar
  75. 75.
    Alessio MG, Tonutti E, Brusca I, Radice A, Licini L, Sonzogni A, et al. Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(1):44–9. PubMed PMID: 22197946.PubMedCrossRefGoogle Scholar
  76. 76.
    Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54(1):136–60. PubMed PMID: 22197856.PubMedCrossRefGoogle Scholar
  77. 77.
    Farrell RJ, Kelly CP. Celiac disease and refractory celiac disease. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtrans gastrointestinal and liver disease – pathophysiology diagnosis management. 9th ed. Philadelphia, PA: Elsevier; 2010.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Internal MedicineColumbia University Medical CenterNew YorkUSA
  2. 2.Department of GastroenterologyColumbia University Medical CenterNew YorkUSA

Personalised recommendations