[Celiac disease].

Abstract

Celiac disease is caused by ingested gluten. In genetically susceptible individuals, it leads to malabsorption of food and nutrients. Characteristically, it has manifested during infancy. Symptoms and signs of malabsorption became obvious within months after starting a gluten-containing diet, and the child typically had chronic diarrhea or loose stools, vomiting, and a distended abdomen. Failure to thrive was a common presentation. These symptoms are those of the classic form of childhood celiac disease. In adults, diarrhea, weight loss, and weakness used to be the classic signs of celiac disease, and a severe malabsorption syndrome was generally found. Nowadays, however, in many countries celiac disease presenting as a malabsorption syndrome is the exception rather than the rule, and a changing symptom pattern has been experienced in both children and adults (1). Clinical celiac disease represents only the tip of the iceberg (Fig. 1). As seen today, celiac disease can still present with the traditional symptoms and signs but usually in a very mild form. Symptoms such as indigestion in adults and recurrent abdominal pain in children are common. A typical monosymptomatic form of the disease is isolated iron deficiency, a sign of malabsorption. Despite the presence of the diagnostic mucosal lesion, the disease can even be symptom-free and clinically silent (Fig. 1). Approximately 10% of the healthy relatives of patients with celiac disease also have silent celiac disease (2).