Coeliac disease

Coeliac disease (aka, celiac disease, non-tropical sprue, coeliac sprue, gluten-sensitive enteropathy) is an autoimmune disease characterised by abnormal reaction of the lining of the small intestine to gluten. The grains wheat, rye, barley, and triticale contain gluten.

Quotes

• Coeliac disease is an autoimmune disorder that primarily affects the small intestine, and is caused by the ingestion of gluten in genetically susceptible individuals. Prevalence in the general population ranges from 0·5% to 2%, with an average of about 1%. The development of the coeliac enteropathy depends on a complex immune response to gluten proteins, including both adaptive and innate mechanisms. Clinical presentation of coeliac disease is highly variable and includes classical and non-classical gastrointestinal symptoms, extraintestinal manifestations, and subclinical cases. The disease is associated with a risk of complications, such as osteoporosis and intestinal lymphoma. Diagnosis of coeliac disease requires a positive serology (IgA anti-transglutaminase 2 and anti-endomysial antibodies) and villous atrophy on small-intestinal biopsy. Treatment involves a gluten-free diet; however, owing to the high psychosocial burden of such a diet, research into alternative pharmacological treatments is currently very active.
  • Carlo Catassi, Elena F. Verdu, Julio Cesar Bai, and Elena Lionetti, (2022) . "Coeliac disease". The Lancet 399 (10344): 2413–2426.

• Celiac disease has been recognized for centuries (Dowd and Walker-Smith 1974) by physicians aware of its major symptoms of diarrhea and gastrointestinal distress accompanied by a wasting away in adults and a failure to grow in children. The Greek physician Aretaeus (first century A.D.) called the condition coeliac diathesis – coeliac deriving from the Greek word koeliakos, or abdominal cavity. The British physician Samuel Gee provided what is generally considered the first modern, detailed description of the condition, which he termed the coeliac affection in deference to Aretaeus, in a lecture presented at St. Bartholomew’s Hospital in London (Gee 1888). At present, celiac disease (or, especially in Britain, coeliac disease) is the most commonly used term for the condition, although various others may be encountered, including celiac syndrome, celiac sprue, nontropical sprue, and glutensensitive enteropathy.
  • Donald Kasarda, "V.E.2 - Celiac Disease by Donald Kasarda; Section IV.E - Food-Related Disorders; Part IV. The Nutrients – Deficiencies, Surfeits, and Food-Related Disorders". The Cambridge World History of Food. vol. I. pp. 1008–1022. doi:10.1017/CHOL9780521402149.112.  (edited by Kenneth F. Kiple and Kriemhild Coneè Ornelas; 1st edition 2000)

• Coeliac disease is an autoimmune disease characterized by small intestinal villus atrophy and inflammation upon exposure to gluten. It has a global prevalence of approximately 1%. Although the gluten-free diet can be an effective treatment, this diet is burdensome with practical difficulties and frequent inadvertent gluten exposure. Moreover, there are a variety of potential complications and comorbidities of coeliac disease that might be related to malabsorption and/or chronic immune activation. Overall, individuals with coeliac disease have increased mortality compared with the general population, underscoring the severity of this common disease. Comorbidities and complications that have been associated with coeliac disease include poor growth, reproductive complications, kidney and liver diseases, respiratory disease (such as pneumonia) and infections (including sepsis). Furthermore, coeliac disease has been linked to other autoimmune disease and psychiatric disease, as well as certain cancers. Data suggest that mucosal healing on a gluten-free diet might protect against some, but not all, of these complications.
  • Jonas F. Ludvigsson, Jialu Yao, Benjamin Lebwohl, Peter HR Green, Shuai Yuan, and Daniel A. Leffler, (2025) . "Coeliac disease: complications and comorbidities". Nature Reviews Gastroenterology & Hepatology 22 (4): 252–264.

• Now this disease was once considered very rare, but in the last probably 10 to 15 years it has become quite common. It's now being diagnosed 20 times as often as it was 30 years ago. Why is this happened? We really don't know. Some people think it might be due to a change in what we're eating or the types of foods we're eating. But really we have no idea why this increase has occurred. This increase parallels other immune diseases like type 1 diabetes and allergy disorders.
  • Joseph A. Murray, M.D., Celiac Disease 101 - An Overview. Mayo Clinic (2026).

• ... For reasons that remain largely unexplained, the incidence of celiac disease has increased more than fourfold in the past sixty years. Researchers initially attributed the growing number of cases to greater public awareness and better diagnoses. But neither can fully account for the leap since 1950. Murray and his colleagues at the Mayo Clinic discovered the increase almost by accident. Murray wanted to examine the long-term effects of undiagnosed celiac disease. To do that, he analyzed blood samples that had been taken from nine thousand Air Force recruits between 1948 and 1954. The researchers looked for antibodies to an enzyme called transglutaminase; they are a reliable marker for celiac disease. Murray assumed that one per cent of the soldiers would test positive, matching the current celiac rate. Instead, the team found the antibodies in the blood of just two-tenths of one per cent of the soldiers. Then they compared the results with samples taken recently from demographically similar groups of twenty- and seventy-year-old men. In both groups, the biochemical markers were present in about one per cent of the samples.
  “That suggested that whatever has happened with celiac disease has happened since 1950,’’ Murray said. “The increase affected young and old people equally.” These results imply that the cause is environmental.
  • Michael Specter, (November 3, 2014) "Against the Grain". The New Yorker.

• Clinical characteristics: Celiac disease is a common systemic autoimmune disease that can develop in genetically susceptible individuals as a response to dietary gluten. Celiac disease can be associated with gastrointestinal findings (e.g., diarrhea, malabsorption, abdominal pain and distention, bloating, vomiting, and weight loss) and/or highly variable non-gastrointestinal findings (dermatitis herpetiformis, iron deficiency anemia, osteoporosis/osteopenia, other nutrient deficiencies, migraines, chronic fatigue, epilepsy, depression, attention-deficit/hyperactivity disorder, joint pain/inflammation, infertility and/or recurrent fetal loss, delayed puberty, growth deficiency, dental enamel hypoplasia, abnormal liver function, autoimmune disorders, and increased risk of cancer). Classical celiac disease, characterized by prominent gastrointestinal symptoms, is less common than non-classical celiac disease, characterized by mild or absent gastrointestinal symptoms. Some individuals with celiac disease have no symptoms despite the presence of immune reactivity to gluten; these individuals are referred to as having silent celiac disease.
  • Annette K. Taylor, Benjamin Lebwohl, Cara L. Snyder, and Peter HR Green, Celiac disease. GeneReviews®[Internet] (2025). excerpt at PubMed

External link

• David Kastenberg, MD and Stephanie Winheld, LCGC, Celiac Diseases in Families: How Genes Determine Your Risk. National Foundation for Celiac Awareness (NFCA). (pdf from webinar sponsored by Philadelphia's Thomas Jefferson University Hospital systems)
• Celiac disease — Symptoms and causes. Mayo Clinic.
• Celiac Disease — Diagnosis and treatment. Mayo Clinic.
• Celiac Disease and Women's Health. Beyond Celiac.