Coeliac disease is caused by hypersensitivity to a component of gluten
Coeliac disease causes atrophy of small intestinal villi due to an abnormal sensitivity
to gluten, a protein in wheat flour (gluten enteropathy).
The disease can present at any age, and in infants and children it is an important
cause of failure to thrive.
Diagnosis is by biopsy of small bowel mucosa.
Histologically the immune-mediated damage causes heavy lymphocytic infiltrate of lamina
propria, and an increase in intraepithelial lymphocytes.
There is also loss of villous architecture, ranging from blunting
(partial villous atrophy) to complete flattening (total villous atrophy),
and an increase in depth of crypts, which produce more epithelial cells to compensate
for those lost through damage.
Complete withdrawal of gliadin from the diet (gluten-free diet)
leads to gradual recovery of villous structure, which may be partial or complete.
Long-term complications of coeliac disease include the development of primary B-cell
lymphoma of the small intestine and, rarely, development of adenocarcinoma.