Celiac disease presents a hereditary disorder of gluten tolerance, i.e. of
gliadin and related prolamins of wheat, rye and barley. It primarily occurs
in Caucasians (1:100-300), while it is considerably or exceptionally rare in
colored races. It is particularly frequent in close relatives of the patient,
as well as in persons with congenital IgA deficiency and in patients with
autoimmune and some chromosomal diseases. The basis of the disease, as well
as the key finding in its diagnostics, lies in small bowel inflammation,
which withdraws on gluten free diet. Beside clinically manifest or
non-manifest enteropathy, changes involving other organs and systems are also
frequently seen. The diagnosis of the manifest form of the disease is based
on characteristic pathohistological finding detected by the examination of
small bowel mucosa in patients on standard diets and their clinical
improvement after the introduction of gluten free diet. However, in the
diagnosis of the asymptomatic form of the disease, it is necessary to perform
enterobiopsy, which confirms the normalization of the appearance of small
bowel mucosa in patients on the elimination diet. In children with gluten
sensitive enteropathy detected in the first two years of life, as well as in
cases in which mucosa samples taken on the first enterobiopsy do not have
typical appearance or are inadequate for a reliable interpretation, a
definite diagnosis is made based on biopsy finding during the provocation of
gluten tolerance. As the quality of permanent teeth can be disturbed, this
procedure is not suggested to be done before the completed age of 6 years,
and due to adverse effects on the growth and development of the child, it
should not be done during puberty. Due to incomplete sensitivity and
specificity, the serological indicators of the disease do not have diagnostic
value. Therefore, they are primarily used in the disclosure of asymptomatic
and atypical forms of celiac disease, as well as in the assessment of the
consistency of elimination diet in cases with already verified disease. In
addition, the application of these tests makes easier passing the decision to
perform pathohistological examination of small bowel mucosa in patients with
provoked gluten tolerance, which also gives a more complete understanding
into the remission of the disease during the initial phase of treatment.