0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
In the Clinic |

Celiac Disease

Sheila E. Crowe, MD
Ann Intern Med. 2011;154(9):ITC5-1. doi:10.7326/0003-4819-154-9-201105030-01005
Text Size: A A A

Celiac disease, also known as gluten-sensitive enteropathy (as well as two older and less preferred terms, nontropical sprue and celiac sprue) is a multisystem disorder estimated to affect approximately 1% of Americans (1). It results from an inappropriate T-cell–mediated immune response to ingested gluten that causes inflammatory injury to the small intestine in genetically predisposed persons. Damage to the proximal small intestinal mucosa results in the malabsorption of nutrients. The average age of diagnosis is in the fifth decade of life but only an estimated 10% to 15% of persons with celiac disease in the United States have been diagnosed (2). The prevalence of celiac disease in the United States seems to have increased 4- to 5-fold over the past 3 to 4 decades (3). Disease manifestations are protean, and gastrointestinal symptoms are not always present. Virtually every body system can be affected, with dermatologic, hematologic, neurologic, musculoskeletal, endocrine, reproductive, and digestive systems most commonly involved. Moreover, celiac disease is associated with a variety of autoimmune conditions whose clinical course may be affected by the diagnosis and treatment of celiac disease. Although patients respond well to treatment with a gluten-free diet, unrecognized or untreated celiac disease is associated with both increased mortality (3, 4) and risk for intestinal lymphoma (5).

First Page Preview

View Large
First page PDF preview

Figures

Grahic Jump Location
Figure 1.

Dermatitis herpetiformis. This disorder is an intensely pruritic papulovesicular rash affecting extensor surfaces, such as the shoulders (top), elbows, knees, back, and buttocks (bottom). Although all patients with dermatitis herpetiformis have the intestinal lesions of celiac disease, few have gastro-intestinal symptoms. Immunofluorescent detection of IgA deposits at the dermal–epidermal junction in a perilesional biopsy of a fresh skin lesion is sufficient for diagnosis and precludes the need for intestinal biopsies.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Endoscopic appearance of celiac disease. Such features include scalloping or notching of the folds, as shown. Fissuring or cracking of the flat intervening mucosa between the folds can also be seen. These endoscopic features are helpful for targeting biopsy sites, but their absence does not rule out the diagnosis; as such, intestinal biopsies should be obtained during upper endoscopy for evaluation of potential celiac disease.

Grahic Jump Location
Grahic Jump Location
Figure 3.

Histologic appearance of celiac disease. Characteristic features of the intestinal mucosa in celiac disease include inflammation and varying degrees of villous atrophy. Inflammation comprises lymphocytes, plasma cells, macrophages, and other chronic inflammatory cells in the lamina propria. It also includes intraepithelial lymphocytes, which are more prominent toward the tips of the villi. The biopsy depicted here shows partial villous atrophy with characteristic inflammatory changes.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
MicroRNAs: An epigenetic tool to study celiac disease. Rev Esp Enferm Dig 2014;106(5):325-333.
Type 1 diabetes mellitus and gluten induced disorders. Gastroenterol Hepatol Bed Bench 2014;7(4):189-97.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)