ABSTRACT
244Celiac disease is an immune-mediated disorder that occurs in genetically predisposed individuals who ingest gluten. Gluten is a dietary protein found in the grains wheat, barley, and rye. In a susceptible person, this gluten-containing diet can lead to the development of an autoimmune enteropathy, causing malabsorption of carbohydrates, proteins, fats, and critical vitamins and minerals. Classically, celiac disease was thought to occur in childhood, after the introduction of gluten in the diet. These children often exhibit gastrointestinal symptoms such as diarrhea, gaseousness, weight loss, and chronic abdominal pain. However, recent research indicates that this disease may present in adulthood with symptoms outside the gastrointestinal tract. Patients with celiac disease may present with extraintestinal symptoms, association with other autoimmune diseases (such as type I diabetes or autoimmune thyroiditis), or may simply have a positive family history for the disease. Testing serum antibodies to gluten and the tissue transglutaminase can screen for the presence of celiac disease. However, the “gold standard” for confirmation of the diagnosis remains a small intestinal biopsy combined with the patient’s clinical response to a gluten-free diet. Clinicians must maintain a high index of suspicion for this disease, as it may present with a myriad of symptoms that closely mimic other diseases. If diagnosed early, the nutritional and malignant complications of long-standing celiac disease can be completely avoided by strict adherence to the gluten-free diet.
