- Celiac disease is a chronic, small intestinal immune-mediated enteropathy caused by intolerance to gluten found in wheat, barley, rye, and other foods when a genetically predisposed person is exposed to the environmental trigger, gluten.
- Celiac disease affects 1 in 100 to 120 adults and 1 in 80 to 300 children in the North American population and appears to be increasing in prevalence.
- The integrity of the tissue junctions of the intestinal epithelium is compromised in patients with celiac disease; this enables gluten to reach the lamina propria. The presence of gluten in the lamina propria and an inherited combination of genes contribute to the heightened immune sensitivity to gluten that is found in patients with celiac disease.
- The classic presenting symptom in adults is diarrhea, which may be accompanied by abdominal pain or discomfort; however, it is noteworthy that during the past decade diarrhea has been reported as the main presenting symptom of celiac disease in less than 50% of cases.
- Dermatitis herpetiformis is a skin manifestation of small intestinal immune-mediated enteropathy caused by exposure to dietary gluten. All patients with celiac disease will not develop dermatitis herpetiformis; however, it is generally agreed that all patients with dermatitis herpetiformis also have celiac disease.
- The frequency of diagnosis of patients with celiac disease has increased; however, the majority of patients with this condition remain undiagnosed.
- A confirmed diagnosis of celiac disease requires both positive findings on duodenal biopsy and a positive response to a gluten-free diet. The most common serologic markers that are used for screening patients are serum anti–tissue transglutaminase antibodies and serum immunoglobulin A (IgA) endomysial antibodies.
- Strict, lifelong adherence to a gluten-free diet is the only treatment for celiac disease that is currently available.
- Clinicians must evaluate the patient with celiac disease for nutritional deficiencies (including folic acid, vitamin B12, fat-soluble vitamins, iron, and calcium) due to malabsorption. Iron-deficiency anemia may be the only presenting sign of disease in patients without diarrhea.
On completion of the chapter, the reader will be able to:
Cite the prevalence of celiac disease.
Describe the proposed etiology of celiac disease.
Discuss the role of gluten in the pathophysiology of celiac disease.
List the presenting signs and symptoms of celiac disease.
Define dermatitis herpetiformis and its relation to celiac disease.
Identify laboratory tests used in the diagnosis of celiac disease.
Explain the negative predictive value of HLA-DQ2/DQ8.
List common misdiagnoses associated with celiac disease.
Discuss the differences in diagnostic approaches used in adults and children <2 years.
List complications of celiac disease.
Select an appropriate gluten-free diet.
Identify challenges to following a gluten-free diet.
Discuss the controversy regarding including oats in a gluten-free diet.
Describe the nutritional deficiencies associated with celiac disease.
Explain the role of the dietitian in the management of celiac disease.
Cite proposed mechanisms of future drug treatments for celiac disease.
Celiac disease is a small intestinal immune-mediated enteropathy caused by intolerance to ingested gluten, ...