1. Coeliac Disease Kamran Rostami Honorary Clinical Lecturer School of Medicine University of Birmingham

7. Serology sensitivity Rostami, Mulder et al. American J Gastroenterol 1999;94:888-894

11. Marsh IIIa or Partial Villous Atrophy (Destructive) Should the relatives of coeliacs -with clinical compliants undergo a small bowel biopsy, in spite of their negative serology ? A complex and prevalent variety of coeliac subgroups Easily missed Negative in serology 60-70% Common presentation in First degree relatives other at high risk 20% of first degree relatives had coeliac disease Rostami K,Mulder C. et al Eur.J.Gastroenterol.Hepatol 2000; 12:51-56 Rostami K, Mulder C et al. Modified Marsh Classification THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 4, 1999 © 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc.

12. Marsh IIIb or Subtotal Villous Atrophy Rostami K, Mulder C et al. Modified Marsh Classification THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 4, 1999 © 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc. Less common and easier to recognise About 70% present with positive serology Very closed to the classical presentation

14. Correlation between sero-sensitivity, endoscopy and Histology Dickey W. Endoscopic markers for celiac disease. Nat Clin Pract Gastroenterol Hepatol. 2006;3:546-51. 31% sensitivity for serology 100% sensitivity for serology

15. Coeliac disease IgG/IgA  -gliadin IgA  -tTG/EMA Mucosal biopsy 3-4 samples Gluten Free Diet Childeren < 2 yrs (-> IgG/IgA  -gliadin Symptoms but no antibodies =>DQ2/8 and biopsy IgA deficiency (prevalence 2% in CD vs 0.2% in normal population) Gluten Free Diet Repeat biopsy Schuppan et al Dig Liv Dis October 2004;10:358-360