Advances in pathogenesis and immunologic diagnosis of celiac disease. Diagnistic protocols in Primary Care

Celiac disease is the more frequent chronic gastrointestinal disease in children. It is the result of gluten intolerance that produces a characteristic villous atrophy of the small intestinal mucosa, in genetically susceptible individuals and with an appropriate environment. Its prevalence has been increasing during the last years probably due to new highly sensitive and specific diagnostic tests has also have modified our current approach to diagnosis of the spectrum of celiac disease. The new diagnostic tools include serological markers (antigliadin, antiendomysial and tissue transglutaminase antibodies) and genetics markers (HLA-DQA1*05 y HLA-DQB1*02). The result of serological tests and the HLA-DQ typing permit to select some patients with high probability to suffer celiac disease that should be confirmed with intestinal biopsy. The suspicion of celiac disease can and must come from Primary Care. It is necessary to establish algorithms of decision and diagnostic protocols for: suspicion of celiac disease, study of relatives and associated diseases. With the analytical results and according to protocols, the Paediatrician in Primary Care could take the appropriate decision in each patients, and in this form he could facilitate the diagnosis.