Introduction and Epidemiology

Celiac disease is a condition characterized by an abnormality of the small intestine caused by the consumption of gluten in the diet. Celiac disease classically has the following three features: small intestinal villous atrophy; symptoms of malabsorption (e.g. steatorrhea, weight loss, nutrient deficiencies); and resolution of symptoms upon withdrawal of gluten containing foods within weeks to months.[1]

It was first described during the second World War by a Dutch pediatrician who observed diarrhea that seemed to correlate with the consumption of grain products in the diet; symptoms disappeared when these grains were unavailable due to shortages during the War. Then in 1954 the histological changes of the proximal small intestine were observed and documented. Those with the condition have an abnormal immune response to gluten, which causes destruction of the villi in the small intestine. Because of this damage to the villi the absorptive ability of the small intestine becomes compromised and nutrient deficiencies can develop.[1]

Celiac disease occurs primarily in those of northern European descent and was originally thought to have a prevalence of 1:8000 to 1:4000. However with more sensitive blood tests some estimates state that as many as 1:250 to 1:100 of those with northern European descent may have some form of celiac.[2]