Celiac disease, also called celiac sprue or gluten-sensitive enteropathy, is a chronic disease of the digestive tract that interferes with the digestion and absorption of food nutrients. Subjects with celiac disease can not tolerate gliadin, a fraction of gluten that is a protein found commonly found in wheat, rye, and barley. When people with celiac disease ingest gliadin, the mucosa of their intestines is damaged by an immunologically mediated inflammatory process, resulting in malabsorption. Patients with celiac disease can present with diarrhoea (classical form), some patients may have only mild symptoms (atypical celiac disease) or are asymptomatic (silent celiac disease).
Patients with celiac disease can be asymptomatic (silent celiac disease), some patients may have only mild symptoms (atypical celiac disease) or can present with diarrhoea or failure to thrive (classical form).
Symptoms of celiac disease can include one or more to the following:
• Chronic diarrhoea
• Steatorrhoea (fat in the stool)
• Abdominal cramps
• Abdominal bloating
• Abdominal gas production
• Weight loss
• Bleeding diathesis
• Seizure disorders
• Growth retardation
• Skin disorders (including dermatitis herpetiformis – a pruritic skin lesion)
Serology. The most sensitive and specific antibodies for the confirmation of celiac disease is tissue transglutaminase IgA, endomysial IgA and reticulin IgA.
Upper endoscopy. Gastroscopy with duodenal biopsies is considered the standard criterion to help establish a diagnosis of celiac disease. The endoscopic findings include reduced mucosal folds and mosaic patterns. In addition, histologic findings from biopsies can demonstrate the atrophy or absence of villi. Serology and endoscopy with biopsies should be considered, especially in patients presenting with classical symptoms, evidence of maldigestion and malabsorption.
The primary treatment is dietary: removal of gluten from diet is essential. A minority of subjects fail to respond to a gluten-free diet. In these refractory patients the use of corticosteroids might be useful.