Celiac Disease and Celiac Crisis

Celiac disease is a permanent immune-mediated response to gluten in wheat, barley, and rye. In a genetically susceptible person, gluten peptides are presented to the immune system and drive inflammation in the small-intestinal mucosa. Villous shortening or flattening reduces absorptive surface area. This produces malabsorption and nutrient deficiencies; celiac disease is therefore more than a food intolerance. HLA-DQ2 or HLA-DQ8 supports genetic susceptibility but does not establish the diagnosis by itself. Presentation is variable and may be intestinal, extraintestinal, or clinically silent. Chronic diarrhea, bulky or greasy stools, abdominal bloating, weight loss, fatigue, iron-deficiency anemia, aphthous ulcers, neuropathic symptoms, reduced bone density, or an itchy blistering rash consistent with dermatitis herpetiformis can be clues. Iron deficiency may precede obvious gastrointestinal symptoms. Folate, vitamin B12, calcium, vitamin D, and other deficiencies can also occur. A normal body weight does not exclude celiac disease. Complications of ongoing intestinal injury include malnutrition, anemia, low bone mineral density, fractures, and persistent or recurrent symptoms. Rarely, severe malabsorption progresses to celiac crisis with dehydration, electrolyte disturbance, metabolic acidosis, renal dysfunction, neurologic dysfunction, or dysrhythmia. Celiac...