Celiac disease (from Greek "koiliakos" meaning "abdominal" is an autoimmune disorder of the small intestine that occurs in genetically predisposed Pt's.

• Immune reaction to a gluten protein found in wheat, but also found in other grains e.g. barley and rye, causing an inflammatory reaction
• Upon exposure to gluten, an abnormal imune response may lead to the production of several different autoantibodies that can affect numerous different organs
• In the small bowel, this caues an inflammatory reaction, that causes villous atrophy, which is shortening of the villi lining the small intestine, thereby affecting nutrient absorption
• This affects the absorption of nutrients

• Pain and discomfort, in the GI tract
• Chronic constipation
• Diarrhea
• Vitamin deficiency
• Failure to thrive (in children)
• Often begins between 6mo-2yo
• Non-classical Sx are the ost common especially in patients >2yo, where there are mild or absent GI Sx, systemic disease, and no obvious Sx
• Anemia
• Fatigue

All tests lose their usefulness if the patient is already eating a gluten-free diet. For those who have already started on a gluten-free diet, it may be necessary to performa  rechallenge, with some gluten-containng food in 1 meal a day over 6 weks before repeating Ix:

• Blood autoantibody tests, first line, although these are frequently negative. Its sensitivyt correlates with the degree of histological lesions
  • Anti-tTG (anti-transglutiminase antibodies) has a sensitivity of 99% and specificity of >90%. It should be performed 1st as it is the easier test to perform
  • Anti-endomysial antibodies of the IgA type can detect celiac with sensitivity and specificity of 99%
  • Anti-gliadin/DGP antibodies (antibodies against deamidated gliadin peptides), which is better than anti-endomysial and anti-transglutimase antibodies in kids <2yo
  • Anti-reticulin, although it is not accurate enough for routine Dx usage
• Endoscopy/gastroscopy and intestinal biopsy, although many people have only minor intestinal changes with normal villi
• Specific genetic testing

• Strict life long gluten-free diet, which leads to recovery of the intestinal mucosa, improves Sx, and reduced risk of developing complications. It includes prohibition of:
  • Wheat
  • Barley
  • Rye
  • Malt
• A small minority of Pt's w/ celiac ALSO react to oats, because of cross-contamination w/ other grains in the field, or distribution channels
• Sources of starch that are acceptable include:
  • Corn (aka maize)
  • Potatoes
  • Rice
  • Tapioca
  • Soy
  • Beans

Patient information

What do you do about gluten protein found in wheat, causing the small intestine lining to blunt?
Well you can stop the gluten . So obviously wheat. But also barley, rye, and malt. If there's also problems with oats, you can stop that, because of cross contamination in the fields.

Anything you CAN eat ???
Yeah, there are starches you can eat. So corn. Potatoes. Rice. Tapioca. Soy. Beans. Lots of things .

• Cancers, e.g. intestinal lymphoma

• Slight increased risk of early death
• Intestinal damage begins to heal within weeks of gluten being removed from the diet

• Other autoimmune diseases, e.g. DMT1, thyroiditis

• Can occur at any age
• The disease is increasingly being made in asymptomatic patients, due to increased screening
• Ranges from 1 in 300 to as many as 1 in 40
• In developed, it is estimated that 83% of cases remain undiagnosed, because of non-classic, minimla, or absent complaints
• Slightly more common in women than men
• Was described by an ancient Greek description by an ancient Greek doctor, Aretaeus of Cappadocia

• Wheat allergy, as Celiac is instead caused by permanent intolerance to wheat proteins