'Flat and flexible truths are beat out by every hammer' (Sir Thomas Browne, 
writer and physician) The prevalence of gluten-sensitive enteropathy (GSE) or 
coeliac disease is likely to be as high as 1:200 to 1:400 in the developed 
world. Current medical practice leaves a significant proportion of these cases 
undiagnosed. An association between untreated coeliac disease and intestinal 
malignancy is well described so it is possible that patients with undiagnosed 
coeliac disease constitute a significant reservoir of preventable 
gastrointestinal malignancy. However, it is not clear whether all patients with 
coeliac disease are equally at risk of malignancy nor are all cases of 
intestinal malignancy necessarily associated with wheat protein sensitivity. 
Thus the precise links between GSE, villous atrophy and malignancy have not yet 
been established. However, there is evidence that products of activated T-cell 
clones, be they antigen specific or malignant, influence epithelial cell 
proliferation, differentiation and function thus contributing to the 
histological lesion characteristic of GSE or small bowel lymphoma.