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Follow up and review are needed when test results are not clear T wo articles in this issue remind us about coeliac disease and the need to consider it as a diagnosis in seemingly unusual circumstances—in elderly patients and in obese patients (p 773, 775).1 2 Furthermore, in the patient reported by Saunders et al, the usual diagnostic features of anti-endomysial and anti-transglutaminase antibodies and histological enteropathy were absent initially.1 Coeliac disease is a relatively common condition. Its prevalence is approximately 0.3-1% of the population in almost all countries and ethnic groups where it has been investigated.3 Previously regarded largely as a childhood problem it is now recognised to affect mostly adults, with about 25% of patients receiving their diagnosis at over 60 years of age.4 When present, the features of malabsorption (diarrhoea and weight loss) should point to the diagnosis, but now a wide range of clinical manifestations are recognised. Patients often have few or no gastrointestinal symptoms and can even be obese.2 5 Conventionally diagnosis is based on the histological finding of …

EDITOR,—In their review on benign positional vertigo Thomas Lempert and colleagues place great faith in the histological finding of particulate matter in the posterior semicircular canal,1 although there is a paucity of evidence that such particles are directly implicated in benign positional vertigo. Schuknecht's original observation was based on two postmortem studies.2 …