Celiac Disease/Other Gastrointestinal Diseases

Celiac disease, also called gluten-sensitive enteropathy or non-tropical sprue, is a disorder primarily affecting the gastrointestinal tract that is characterized by chronic inflammation of the mucosa, which leads to atrophy of intestinal villi, malabsorption, and protean clinical manifestations which may begin either in childhood or adult life.

Symptoms can include abdominal cramping, bloating, and distention, and untreated celiac disease may lead to vitamin and mineral deficiencies, osteoporosis and other problems.

The disease is also strongly associated with the skin disorder, dermatitis herpetiformis. Celiac disease's major genetic risk factors (HLA-DQ2 and HLA-DQ8), and environmental trigger (specific peptides present in wheat, rye and barley) have been identified and most patients experience complete remission after exclusion of these grains from the diet. Thus, there has been considerable scientific progress in understanding this complex disease and in preventing or curing its manifestations by dietary interventions.

At the present time, celiac disease is widely considered to be a rare disease in the United States. However, recent studies, primarily in Europe but also in the United States, suggest that its prevalence is much higher than previous estimates, raising the concern that the disease is widely under-recognized. The disease is most common in Caucasians and occurs only occasionally in African blacks and not in Asians (see epidemiology). Some patients with celiac disease may be at risk for non-Hodgkin's lymphoma, a rare cancer affecting the gastrointestinal tract. It is not yet clear, however, what the impact of this observation should be on diagnostic and treatment strategies.

Immunoglobulin A (IgA) deficiency is 10 to 15 times more common in patients with celiac disease (CD) than in healthy subjects (Prevalence in healthy subjects: 1 of 600 to 800). Hence, IgA-deficient patients with CD may yield false-negative serology, when only IgA isotypes are measured in serodiagnosis.