Celiac Disease

Excerpt

Celiac disease is an autoimmune disorder triggered by an immune-mediated response of the small intestine to dietary gluten, which is a protein found in wheat, barley, and rye. Although traditionally viewed as a gastrointestinal condition primarily associated with malabsorption, it is now more accurately classified as an autoimmune disorder with systemic manifestations. Celiac disease occurs in genetically predisposed individuals and results in a lifelong condition characterized by immune-mediated damage to the lining of the small intestine due to the immune response to gluten. This damage is evidenced by villous atrophy, crypt hyperplasia, and infiltration of the lamina propria by immune cells, which in turn leads to malabsorption of essential nutrients, including micronutrients, fat-soluble vitamins, iron, vitamin B12, and folate. Typical gastrointestinal symptoms include diarrhea, abdominal discomfort, bloating, and constipation. However, celiac disease can also present with extraintestinal manifestations such as fatigue, weight loss, skin rashes, anemia, and osteoporosis. Growth failure is a frequent additional symptom in children with celiac disease (see Image. Intestinal Changes in Celiac Disease).

Detection of disease-specific antibodies, such as anti-tissue transglutaminase (tTG)–immunoglobulin A (IgA) or "tTG-IgA" and anti-endomysial antibodies (EMAs), is a key initial step in diagnosing suspected celiac disease. Most patients require a small intestinal biopsy to confirm the diagnosis and assess the extent of mucosal damage. The only effective treatment for celiac disease is the strict and complete exclusion of gluten from the diet, which involves lifelong adherence to a strict gluten-free diet (GFD). Maintaining a GFD is essential for symptom resolution and the prevention of long-term complications, with most patients responding well to this dietary modification. Regular medical follow-up is necessary to monitor adherence and promptly identify and manage any disease-related complications.