Celiac disease patients may suffer from a number of extra-intestinal diseases related to long-term gluten ingestion. The diagnosis of celiac disease is based on the presence of a manifest small intestinal mucosal lesion. Individuals with a normal biopsy but an increased risk of developing celiac disease are referred to as potential celiac disease patients. However, these patients are not treated. This review highlights that patients with normal biopsies may suffer from the same extra-intestinal gluten-induced complications before the disease manifests at the intestinal level. We discuss diagnostic markers revealing true potential celiac disease. The evidence-based medical literature shows that these potential patients, who are “excluded” for celiac disease would in fact benefit from gluten-free diets. The question is why wait for an end-stage disease to occur when it can be prevented? We utilize research on dermatitis herpetiformis, which is a model disease in which a gluten-induced entity erupts in the skin irrespective of the state of the small intestinal mucosal morphology. Furthermore, gluten ataxia can be categorized as its own entity. The other extra-intestinal manifestations occurring in celiac disease are also found at the latent disease stage. Consequently, patients with celiac traits should be identified and treated.

Coeliac disease (CD), due to its protean clinical manifestation, is still very under diagnosed in adults and delays in diagnosis may take years and even decades. Simple tools to find cases in primary care may help to identify patients for further diagnostic tests. We have evaluated the usefulness of an on site rapid fingertip whole blood point-of-care test (POCT) for such a purpose.

Background. Celiac disease (CD) is significantly underdiagnosed, despite significant efforts made in the last decades to increase its diagnostic rate. This has lead to a high need for developing new diagnostic strategies. Our aim was to evaluate the diagnostic performance of two routine hematologic indices for CD. Methods. In a prospective observational study, 34 newly diagnosed CD patients, 34 age-sex matched controls with irritable bowel syndrome (IBS) and 16 treated CD patients were assessed regarding the differences in mean lymphocyte count (LY), red blood cell distribution width (RDW) and their ratio (RDW/LY). Results. Elevated RDW (>14) and lymphopenia (<1.5 x 10e9/L) were more frequently seen in newly diagnosed CD patients compared to IBS control group and treated CD patients. Newly diagnosed CD patients had significantly higher mean values of RDW/LY - 10.09, compared to 7.72 in the CD-treated group and 6.79 in IBS controls (p<0.01). Subgroup analysis revealed that RDW/LY was higher in patients with destructive histology (Marsh≥3a), 10.54 vs. 7.99. For a value over 7, RDW/LY had a sensitivity of 88.24% (95% CI 72.55-96.70%) and AUROC of 0.785 (95% CI 0.683- 0.887). Conclusions. RDW/LY ratio is a widely available tool which could be used routinely in clinical practice for CD screening.

Background: Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. Case presentation: We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy.Conclusions: Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.