intestine and provide an increased the surface area for
absorption. Damage to the villi results in inadequate
absorption, especially ofvitamins,minerals,andfats.
Celiac disease is an autoimmune disease. When-
ever immune system cells in the body sense the pres-
ence of foreign material, they produce proteins called
antibodies that act to disable the foreign material. In
an autoimmune disease, the body treats some of its
own cells as foreign and attacks them. Celiac disease is
also classified as a malabsorption disease because the
cells that are damaged by the body’s immune system
are cells of the villi lining the small intestine. When
these cells are damaged, the villi flatten out, decreasing
the surface area available for absorption. Nutrients
are not properly absorbed, and vitamin and mineral
deficiencies often develop.
The symptoms of celiac disease were describe as
early as 1888, but it was not until the 1950s that
physicians began to understand what caused the dis-
ease. A Dutch pediatrician, W. K. Dicke, was the first
person to make the connection between the consump-
tion of foods containing wheat and symptoms of celiac
disease. Today researchers know that the problem
substance is gluten found in wheat, rye, and barley,
and products such as four, bread, and pasta made
from these grains. The role of oats and oat products
in celiac disease remains controversial.DemographicsCeliac disease is most common among people of
Northern European ancestry and is uncommon to rare
among people of African or Asian ancestry. Initially
celiac disease was thought to be uncommon in the
United States, but recent improvements in genetic test-
ing and disease awareness have changed that picture.
Experts now believe that in the United States and
other areas of the world settled primarily by Euro-
peans (e.g. Australia), about 1 of every 133 people
has celiac disease. The disease has an inherited com-
ponent, and the rate increases to 1 of every 22 people
who are blood relatives of a parent, sibling, or child
with the disease. In about 70% of identical twins, if
one has celiac disease, the other also has it. Celiac
disease is also more common among people with
other genetically-related autoimmune diseases such
as systemic lupus erythematosus, type 1 diabetes (juve-
nile diabetes), rheumatoid arthritis, and autoimmune
thyroid disease.
People of any age can be diagnosed with celiac
disease. However, there are two common peaks for
diagnosis, one between 8–15 months, which is shortly
after infants usually begin eating wheat products, and
another between 30–40 years in adults.Causes and symptomsResearchers have traced the genetic component of
celiac disease to a cluster of genes on chromosome six.
Multiple genes are involved, which may account for
the variation in symptoms and inheritability of the
disease. Often, symptoms of the disease develop after
a serious infection, physical trauma, pregnancy, or
surgery. Researchers do not know why stress on the
body appears to trigger symptoms.
Symptoms of celiac disease are varied. Some peo-
ple have the disease (as diagnosed by samples that
show damage to the small intestine), but they show
no symptoms. Others go along for years with annoy-
ing or intermittent symptoms, and some, especially
children, show severe symptoms of malnutrition that
stunt growth despite eating a healthy diet. Symptoms
are similar to those of other, more common,digestive
diseases. Often celiac disease is initially misdiagnosed.
Common symptoms of celiac fall into two catego-
ries, those primarily related to the immediate prob-
lems of digesting food and those that result mainly
from long-term deficiencies in vitamins and minerals.Light micrograph of healthy villi (tiny finger-like projections)
on the lining of the small intestine. When people with celiac
disease eat foods or use products containing gluten, their
immune system responds by damaging or destroying the
villi. Villi allows nutrients from food to be absorbed into the
bloodstream; without healthy villi, a person becomes
malnourished, regardless of the quantity of food eaten.(Eye
of Science/Photo Researchers, Inc. Reproduced by permission.)
Celiac disease