Celiac disease (CD) occurs in genetically predisposed individuals who demonstrate a permanent intolerance to gluten, found in wheat, barley, and rye. This leads to the development of an autoimmune enteropathy, resulting in the malabsorption of critical vitamins, minerals, and calories. Signs and symptoms of the disease classically include diarrhea, short stature, iron-deficient anemia, and chronic abdominal pain. However, patients may present with another autoimmune disease (such as type I diabetes) or a family history of the disease, with no gastrointestinal symptoms. Serum antibodies can be used to screen for CD. However, the keys to confirming the diagnosis remain a small intestinal biopsy and the patient's clinical response to a gluten-free diet. Clinicians in the United States must maintain a high index of suspicion for CD, because it is significantly underdiagnosed in this country.
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