ABSTRACT
This chapter begins with a discussion of the inflammatory lesion associated with celiac disease. The multifaceted aspect of celiac disease makes the disorder especially fascinating and highly relevant to mucosal immunology in particular. Celiac disease is a chronic, T-cell–mediated, inflammatory disorder of the small intestine resulting from an inappropriate immune response to gluten. The mucosal pathology associated with celiac disease is localized to the proximal small intestine and is characterized by villus atrophy and prominent infiltration of leukocytes into the epithelium and lamina propria. The histological lesion in active celiac disease is strikingly different from that of other T-cell–mediated enteropathies, such as graft-versus-host disease and autoimmune enteropathy. An array of immunocompetent cells is present in the small intestinal mucosa in celiac disease. The diagnosis of celiac disease in a person on a gluten-free diet is problematic, because in the absence of gluten ingestion, the clinical signs, serology, and morphology return to normal.
