What is celiac disease?

Celiac disease is a permanent intolerance to gluten proteins found in a number of widely consumed cereal grains; including wheat, barley, spelt, rye, KAMUT®, and triticale [1]. In children and adults with genetic predisposition, the ingestion of foods containing gluten causes an autoimmune reaction in the intestine. This results in chronic inflammation of the small intestinal mucosa and truncation of the villi, therefore reducing the absorptive capacity of the small intestine. If untreated, these characteristic histopathological changes result in malabsorption of key micronutrients and consequent nutritional deficiencies. While intestinal damage is the hallmark of celiac disease, presentation of symptoms ca vary from the classic gastrointestinal to skin manifestations of Dermatitis Herpetiformis to infertility and bone loss [2]. However, adherence to a strict gluten-free diet allows regeneration of the villi and resolution of symptoms. A lifelong gluten-free diet, in which all traces of gluten are avoided, is currently the only treatment available for the management of this condition.

Prevalence

Celiac disease is more common than is often assumed. In North America, 1 in 100 people are believed to have celiac disease, yet current research shows only 24% are actually diagnosed [3,4,5] largely due to the diverse presenting symptomatology.

Oslo definitions of celiac disease

Due to lack of consensus on the use of terms related to celiac disease and gluten, a multi-disciplinary task force of international physicians was convened to agree a set definitions for the various types of celiac disease based on presentation and symptoms, these were updated in 2013, and are referred to as ‘the Oslo definitions’ for celiac disease and related terms [6].

Classical celiac disease

Celiac disease presenting with signs and symptoms of malabsorption. Diarrhea, steatorrhea, weight loss or growth failure is required.
 

Non-classical celiac disease

Celiac disease presenting without signs and symptoms of malabsorption.
 

Subclinical celiac disease

Celiac disease that is below the threshold of clinical detection and without signs or symptoms sufficient to trigger celiac testing in routine practice.
 

Symptomatic celiac disease

Celiac disease characterized by clinically evident gastrointestinal and/or extra-intestinal symptoms attributable to gluten intake.
 

Potential celiac disease

Individuals with a normal small intestinal mucosa who are at increased risk of developing celiac disease as indicated by positive celiac serology.
 

Refractory celiac disease

Persistent or recurrent malabsorptive symptoms with villous atrophy despite a strict gluten free diet for more than 12 months.