Celiac Disease (Celiac Sprue, Gluten Enteropathy)

Overview

• An autoimmune malabsorption syndrome mainly affecting the small intestine—particularly the duodenum and jejunum.
• Occurs when the immune system reacts to gluten, damaging intestinal villi and impairing nutrient absorption.

Causes and Risk Factors

• Genetic predisposition: Often runs in families.
• Autoantibodies: The immune system produces antibodies that attack the intestinal lining.
• Enzyme defect:
  • Impaired breakdown of gliadin, a component of gluten.
• Associated conditions:
  • Type 1 diabetes.
• Onset:
  • Usually during childhood, but can occur in adults.

Pathophysiology

• Immune attack causes atrophy of intestinal villi:
  • Shortening and flattening of villi reduce surface area.
  • Loss of villi diminishes the intestine’s ability to absorb nutrients.
• Consequences:
  • Malabsorption of multiple nutrients including fats, proteins, and minerals.
  • Steatorrhea: Fatty, greasy diarrhea.
  • Failure to thrive: Poor weight gain, muscle wasting.
  • Iron deficiency anemia.
  • Nutritional deficits affect brain function, causing irritability, fatigue.

Symptoms

• Onset: Usually when gluten-containing foods are introduced (4-6 months).
• Signs:
  • Diarrhea, bloating, steatorrhea.
  • Failure to gain weight.
  • Muscle loss.
  • Iron deficiency anemia.
  • Irritability, fatigue.
• Long-term risks:
  • Increased likelihood of intestinal lymphoma.
  • Development of osteoporosis due to malabsorption of calcium and vitamin D.

Diagnosis

• Blood tests:
  • Check for autoantibodies (e.g., anti-tissue transglutaminase).
• Endoscopy with biopsy:
  • Visual confirmation of villous atrophy.
  • Biopsy supports diagnosis of intestinal damage.

Treatment

• Gluten-free diet:
  • Avoid wheat, barley, rye, oats.
  • Be aware of hidden gluten in processed foods.
• Outcome:
  • Villi usually regenerate within weeks if diet is strict.
  • Lifelong adherence required to prevent relapse and complications.

Visual Comparison

• Normal small intestine:
  • Numerous villi to maximize surface area.
• Celiac disease:
  • Flattened villi with loss of absorptive surface.