Diagnosis of coeliac disease

Diagnosis is usually made by small bowel biopsy showing evidence of villous atrophy. Elevated blood levels of antigliadin and antiendomysium antibodies are detectable in most untreated cases. These antibodies are a valuable 'screening' test in patients with diarrhoea but they are not a substitute for small bowel biopsy and become negative with successful treatment.

Other investigations are usually unnecessary. Barium follow-through X-rays show dilated loops of bowel, coarse or diminished folds and sometimes flocculation of contrast. Sugar tests of intestinal permeability are abnormal and a modest degree of fat malabsorption is usual.

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