| Heterogeneity of celiac disease: clinical, pathological, immunological, and genetic. | |
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MedLine Citation:
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PMID: 9928374 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In this paper we consider recent new data on the pathological features of gluten sensitivity and on the disease-associated antigens, in the context of a multistage hypothesis that we have been developing for the last five years. This incorporates concepts of oral tolerance induction, mucosal T-cell and antibody-mediated injury, and genetic contributions. Until now, there has been complete agreement that the diagnosis of celiac disease must be based on small bowel histology. There are patients with low-grade gluten-sensitive enteropathy, in whom the only morphological abnormality is a high count of intraepithelial lymphocytes (IEL). Some, but not all, also have positive serum IgA anti-endomysium antibody (AEA). With good techniques, in a properly accredited laboratory, in a patient suspected on clinical grounds to have celiac disease, a positive serum IgA AEA test (perhaps, alternatively, high-titer anti-transglutaminase by ELISA), is virtually diagnostic of the condition. Our hypothesis of a stepwise pathogenesis of severe gluten-sensitive enteropathy is re-examined in the light of these new data. It is evident that there are at least five different levels at which genetic influences may operate. |
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Authors:
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A Ferguson; H Gillett; K Humphreys; K Kingstone |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Annals of the New York Academy of Sciences Volume: 859 ISSN: 0077-8923 ISO Abbreviation: Ann. N. Y. Acad. Sci. Publication Date: 1998 Nov |
Date Detail:
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Created Date: 1999-02-24 Completed Date: 1999-02-24 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7506858 Medline TA: Ann N Y Acad Sci Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 112-20 Citation Subset: IM |
Affiliation:
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University of Edinburgh Department of Medicine, Western General Hospital, United Kingdom. Anne.Ferguson@ed.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Celiac Disease / genetics, immunology, pathology, physiopathology* Humans Lymphocyte Activation T-Lymphocytes / immunology |
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