Coeliac disease: changing diagnostic criteria?

1 Coeliac disease (CD) is a chronic, multisystemic, autoimmune disorder, induced by gluten exposure, in genetically sensitive individuals (1-3). Its clinical presentation is extremely various, and changes considerably from full-blown malabsorption syndrome, seen in the classic childhood-onset disease, to subtle and atypical symptomatology, especially in the lateonset forms. The prevalence of CD varies widely in different parts of the world; however recent studies, employing new highly sensitive and specific serologic assays, have shown it to be a fairly common disease worldwide, about 1% in general population. This variability is most probably due to the differences in the diagnostic protocols used, the level of public health awareness, the nutrition habits (large use of gluten free cereals – i.e. rice, corn) and also, partially, to the true differences in the incidence of the disease (4). Until now, despite this clinical variability and the discover of new diagnostic tools, small bowel mucosal biopsy has remained the gold standard for CD diagnosis. Anyway recently the histological dogma is under criticism and new rules have been proposed. According to this changing of believe, European Society for Pediatric Gastroenterology,