Celiac Disease

This chapter discusses the background, diagnosis, treatment, and prognosis for celiac disease (CD). CD is a chronic, small intestinal, immune-mediated enteropathy precipitated by exposure to dietary gluten and related prolamins in genetically predisposed individuals. Clinical manifestations of celiac disease range from the completely asymptomatic patient to the severely affected patient with classic signs including bulky, foul-smelling, floating stools due to steatorrhea and flatulence. A number of non-gastrointestinal manifestations of CD can also be present. A hallmark of CD is the presence of antibodies directed against transglutaminase (anti-TTG) that can be detected in the serum. Histopathologically, blunted or atrophic villi, crypt hyperplasia, mononuclear infiltration of the lamina propria, structural abnormalities in epithelial cells, and intraepithelial lymphocytic infiltration are seen in an intestinal biopsy of a patient with CD. The cornerstone of treatment of CD is elimination of gluten from the patient's diet.