Celiac disease involves inflammation and damage caused to the inner lining of the small intestines due to an autoimmune process.
Classification of celiac disease
- Classical celiac disease – this has predominant gastrointestinal symptoms.
- Atypical celiac disease – this has mostly non-gastrointestinal symptoms and symptoms if present may be single or less in severity.
- Silent celiac disease with no symptoms
Some of the diseases that need to be ruled out while making a diagnosis of celiac disease include:-
- Tropical sprue, collagenous sprue and refractory sprue
- Enteropathy caused by HIV/AIDS or due to combined immunodeficiency or due to autoimmune enteropathy
- Damage to the intestines due to radiation and/or chemotherapy
- Graft-versus-host disease after an organ transplant
- Chronic ischemia of the gut
- Inflammatory bowel disease like Crohn’s disease
- Eosinophilic gastroenteritis
- Zollinger–Ellison syndrome
- Enteropathy-associated T-cell lymphoma
Diagnostic pathway for detecting celiac disease
Suggested diagnostic pathway for detecting celiac disease includes:–
Once these abnormalities are detected, an intestinal biopsy is recommended. More than one biopsy is taken from the second or third part of the duodenum. Best samples are obtained with the suction biopsy using a Crosby capsule.
Once the biopsy is mounted on a slide it shows definitive findings under the microscope. The mucosa of the proximal small intestine is affected and the damage shows decreasing intensity towards the distal small intestine.
In more severe cases the damage may extend up to the ileum. In silent cases or asymptomatic cases the damage is mild.