Celiac Disease

• Abnormal jejunal mucosa due to intestinal reaction to alpha-gliadin antigen in gluten (found in barley, rye, oats and wheat)
• Associated with other autoimmune diseases
• Women > men; family history; peaks in infancy and old age

Presentation

• Malabsorption: diarrhea, weight loss, anemia, symptoms of vitamin/mineral deficiency (most severe in proximal bowel affecting Fe, Ca and folic acid)
• Improves with gluten-free diet
• May be associated with dermatitis herpetiformis skin eruption 

Investigations

• Small bowel mucosal biopsy (4-5 samples, as disease may be patchy)
  • Villous atrophy and crypt hyperplasia
  • Infiltration of the lamina propria with chronic inflammatory cells
• Clinical response to gluten-free diet
• Antigliadin antibodies (AGA), Antiendomysial antibodies (EMA), Tissue transglutaminase antibodies  (tTG)
• Levels of ferritin/Fe saturation, Ca, Fe, albumin, cholesterol, carotene, B­₁₂ – assess for malabsorption

Treatment

• Gluten free diet – no barley, rye, oats, wheat
• If symptoms continue consider:
  • Erroneous diagnosis
  • Gluten ingestion
  • Cow milk, soy, “food” sensitivity
  • Intestinal lymphoma
  • Concurrent disease (pancreatic insufficiency)
  • Lactase deficiency