Potential and latent coeliac disease

Potential and latent forms of coeliac disease exist and may cause symptoms that respond to a gluten-free diet. The presence of serum endomysial antibodies is a marker of these forms of coeliac disease. Tests are available to determine whether changes in the mucosa in suspected cases are gluten sensitive. Ideally, patients with unexplained diarrhoea should not be given a gluten-free diet unless there is evidence of gluten sensitivity, although at present few laboratories offer the necessary tests. A single normal biopsy does not exclude the diagnosis of coeliac disease for life and, in groups at risk of developing it, such as those with type 1 diabetes and relatives of coeliac disease patients, serial measurements of antibodies associated with coeliac disease and repeat biopsies are warranted if suspicion remains about the diagnosis. This case report details a child with coeliac disease and giardiasis. Treatment of the infection without recourse to a gluten-free diet cured the symptoms of diarrhoea and returned the small intestinal morphology to normal. Thus, the patient moved from active to latent coeliac disease. Potential and latent forms of coeliac disease are being increasingly recognized, since markers have become available to identify patients and investigations developed to test for gluten sensitivity in the small intestinal mucosa. This case provides an opportunity to consider potential and latent forms of coeliac disease and how these impact on clinical practice and the wider understanding of the disorder.