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What Is Celiac Disease in the First Place?

Story at-a-glance

  • Celiac disease is defined as an autoimmune condition wherein patients experience a reaction in the small intestine after consuming products with gluten
  • Refractory celiac disease is also linked to gliadin, a component of gluten that works together with similar proteins in barley and rye, causing the immune reaction

Celiac disease is defined as an autoimmune1 condition wherein patients experience a reaction in the small intestine after consuming products with gluten. This protein is found in whole grains such as wheat, barley or rye, and its byproducts, like cereal, bread and beer.

This response damages the small intestine’s lining called the villi and causes malabsorption (prevention of nutrient absorption). It could also lead to diarrhea, fatigue, weight loss, bloating and anemia.2

This disease is known as gluten-sensitive enteropathy,3 coeliac disease (in countries like the U.K. and Australia), celiac sprue disease and non-tropical sprue.4

Complications of Celiac Disease

If left untreated, celiac disease can trigger these complications among adults and children:5,6

MalnutritionFailure to thrive
Loss of calcium and bone densityDelayed puberty
OsteoporosisWeight loss
Lactose intoleranceIrritability
Dermatitis herpetiformis7 (a condition wherein the patient experiences a chronic and extremely itchy rash on the skin consisting of bumps and blisters8)Dental enamel defects
Autoimmune thyroid diseaseAnemia
Infertility and miscarriageArthritis
Neurological problems
Cancers (lymphoma and small bowel cancer)

There are two types of celiac disease that can affect a patient even after a diagnosis has been made and a treatment protocol has been recommended:9

Nonresponsive celiac disease: A condition that affects around 30 percent of people with celiac disease, patients may not have or be able to maintain a good response to a gluten-free diet within about six months.10 They experience recurring celiac disease symptoms because of:11

Co-existent inflammatory bowel disease

Microscopic or inflammatory colitis

Small bowel bacterial overgrowth

Lactose intolerance

Functional bowel disorders

The usual symptoms of nonresponsive celiac disease include abdominal pain, diarrhea, weight loss and fatigue.12

Refractory celiac disease: Despite a strict adherence to a gluten-free diet, patients with this disorder experience continuous intestinal injuries that lead to malabsorption. If symptoms of celiac disease occur even if the patient has followed a gluten-free diet for a year, the physician could recommend further testing to look for other causes of the condition.

This disease is also called intractable celiac sprue, and is divided into two subtypes: type 1 refractory sprue and type 2 refractory sprue.13 This illness is very rare, developing in only 1 to 2 percent of people with celiac disease. In most cases, the patients are 50 years old and above; the illness is almost never seen in children.14

The cause of refractory celiac disease is still undetermined, but the body’s immune system, especially T lymphocytes, intraepithelial lymphocytes (IEL), cytokines and antigens are said to play a role.15

Refractory celiac disease is also linked to gliadin, a component of gluten that works together with similar proteins in barley and rye, causing the immune reaction. Symptoms of refractory celiac disease are quite similar to untreated celiac disease, but they are more severe and more disabling.16

Is Celiac Disease Genetic?

Having a relative, whether of first- or second-degree,17 with celiac disease can increase your risk for the illness. There are also ailments and environmental factors that are known risk factors for celiac disease:18

IllnessesEnvironmental Factors and Events
Rheumatoid arthritisInfant feeding practices
Type 1 diabetesGastrointestinal infections
Down syndrome or Turner syndromeUnbalanced gut bacteria
Microscopic colitis (either lymphocytic or collagenous colitis)Surgical procedures
Autoimmune thyroid diseaseChildbirth
Addison's diseasePregnancy

Viral infection/s

Severe emotional stress


Celiac Disease: Introduction

What Is Celiac Disease?

Celiac Disease In Children

Celiac Disease Causes

Celiac Disease Types

Celiac Disease Symptoms

Celiac Disease Diagnosis

Celiac Disease Treatment

Celiac Disease Prevention

Celiac Disease Diet

Celiac Disease FAQ

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Celiac Disease In Children

Sources and References

  • 1 “What Is Celiac Disease?” NIH MedlinePlus, Spring 2015
  • 2, 4 “What Is Celiac Disease?” Celiac Disease Foundation
  • 3 Mayo Clinic Staff, “Celiac disease Overview,” Mayo Clinic, August 17, 2016
  • 5, 9, 18 Mayo Clinic Staff, “Celiac Disease Symptoms and causes,” Mayo Clinic, August 17, 2016
  • 6 “Associated Conditions and Complications,” Coeliac UK
  • 7 ehbi and Anand, “Celiac Sprue (cont.),” EMedicineHealth, May 26, 2016
  • 8 Berman, Zieve, Ogilvie and the A.D.A.M. Editorial Team, “Dermatitis Herpetiformis,” MedlinePlus, April 4, 2015
  • 10, 12 Madden, “Nonresponsive Celiac Disease,” Gluten-Free Living, June 26, 2014
  • 11 “Non-responsive and Refractory Coeliac Disease,” Coeliac UK
  • 13, 14, 15, 16 Kelly, “Refractory Celiac Disease,” National Organization for Rare Disorders, 2016
  • 17 “Celiac Disease Facts and Figures,” The University of Chicago Medicine Celiac Disease Center
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