Coeliac disease today: the search for complications and associated disorders

Coeliac disease is chronic, immune-mediated enteropathy triggered by ingestion of gluten. Coeliac disease is often preceded and/or accompanied with associated disorders such as IgA deficiency, Down’s syndrome and autoimmune disorders (diabetes mellitus, autoimmune thyroid illnesses, Sjögren’s syndrome, Addison disease, autoimmune liver diseases). Patients with coeliac disease have increased incidence of malignancy, especially non-Hodgkin’s lymphoma, with the greatest risk for EATCL (Enteropathy Associated T-Cell Lymphoma). This risk of developing malignancy can be explained by increased chromosomal instability, which has been found in patients with coeliac disease. At the Referral Centre for Paediatric Gastroenterology and Nutrition we have shown that patients with coeliac disease have a 5 to 6 times greater increase of chromosomal aberrations in the peripheral lymphocytes than the general population, and this increase can be abrogated by a strict gluten-free diet. The aim of this paper is to present different clinical presentations, complications and associated disorders of coeliac disease, with a special emphasis on malignant complications.