International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2020, 8(1), 22-27
DOI: 10.12691/ijcd-8-1-4
Open AccessReview Article

Celiac Disease and Its Clinical Manifestations

Poornima Sharma1, Shaik Khasimbi2 and Sharad Wakode2,

1Department of Quality Assurance, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India

2Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India

Pub. Date: April 27, 2020

Cite this paper:
Poornima Sharma, Shaik Khasimbi and Sharad Wakode. Celiac Disease and Its Clinical Manifestations. International Journal of Celiac Disease. 2020; 8(1):22-27. doi: 10.12691/ijcd-8-1-4


Celiac disease (CD) is associated with activation of the immune response toward specific protein commonly known as gluten, Which causes damage to the small finger-like projections called villi. Samuel was the first person who describes the disease in the year 1887. The given review article describes various factors which are associated with CD such as genetic factors, environmental factors and proteins. Chronic diarrhea, Hypochromic anemia, Short stature, Bone loss, Recurrent abortions, Hashimoto’s disease, etc are some common clinical manifestation. Along with clinical manifestations, we will also discuss the diet for the patients and treatment approaches.

celiac disease autoimmune disorder small intestine gluten villi

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[1]  Thomas C. “On the coeliac affection. In: Major Classic descriptions of disease”. Springfield, IL: Charles C. Thomas 1945, 600-601.
[2]  McDonald WC, Dobbins WO III, Rubin CE. “Studies of the familial nature of celiac sprue using biopsy of the small intestine”. N Engl J Med. 1965, 272: 448-456.
[3]  Benecke R. Ueber die Spruekrankheit (Aphthae tropicae). Verh Dtsch Ges Pathol, 1910; 14: 132.
[4]  Mawhinney H, Tomkin GH. “Gluten enteropathy associated with selective IgA deficiency”. Lancet, 1971, 2: 121-124.
[5]  Howell MD, Austin RK, Kelleher D, Nepom GT, Kagnoff MF. “An HLA-D region restriction length polymorphism associated with celiac disease”. J Exp Med, 1986, 164: 333-339.
[6]  Ferguson A, MacDonald TT, McClure JP, Holden RJ. “Cell-mediated immunity to gliadin within the small-intestinal mucosa in celiac disease”. Lancet, 1975, 1: 895-897.
[7]  Cataldo F, Montalto G. “Celiac disease in the developing countries: a new and challenging public health problem”. World J Gastroe, nterol. 2007, 13: 2153-2159.
[8]  Paulley JW, Fairweather FA, Leeming A. “Post-gastrectomy steatorrhoea and patchy jejunal atrophy”. Lancet, 1957, 272: 406-407.
[9]  Taylor AK, Lebwohl B, Snyder CL, Green PHR. Celiac disease. In: Pagon RA, Adam MP, Ardinger HH. “Gene Reviews”. Seattle, WA: University of Washington; 2015.
[10]  Allué IP, Pediátrica N. Enfermedad celíaca presente y futuro. Madrid, España:Ergon; 2013
[11]  Lundin KE, Wijmenga C. “Coeliac disease and autoimmune disease-genetic overlap and screening”. Nat Rev Gastroenterol Hepatol, 2015, 12 (9): 507-1
[12]  Molina-Infante J, Santolaria S, Montoro M, Esteve M, Fernández-Bañares F. “Non-celiac gluten sensitivity: a critical review of current evidence”. Gastroenterol Hepatol, 2014, 37 (6): 362-71.
[13]  Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, Hadjivassiliou M, Kaukinen K, Kelly CP, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C. “The Oslo definitions for coeliac disease and related terms”. Gut (Review). 2013, 62 (1): 43-52.
[14]  Zis P, Hadjivassiliou M. “Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease”. Curr Treat Options Neurol (Review). 2019, 21 (3):10.
[15]  Lu Shan, Øyvind Molberg, Isabelle Parrot, Felix Hausch, Ferda Filiz, Gary M. Gray, Ludvig M. Sollid, Chaitan Khosla. “Structural basis for gluten intolerance in celiac”. sprue. Science, 2002, 297: 2275-9.
[16]  Heel DA, West J. “Recent advances in coeliac disease”. Gut, 2006; 55(7): 1037-46.
[17]  Greco L, Romino R, Coto I, Di Cosmo N, Percopo S, Maglio M, Paparo F, Gasperi V, Limongelli MG, Cotichini R, D'Agate C, Tinto N, Sacchetti L, Tosi R, Stazi MA. “The first large population based twin study of coeliac disease”. Gut, 2002, 50: 624-8.
[18]  Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, Emery LM, Sokol RJ, Erlich HA, Eisenbarth GS, Rewers M. “Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease”. JAMA, 2005, 293:2343-51.
[19]  Stene LC, Honeyman MC, Hoffenberg EJ, Haas JE, Sokol RJ, Emery L, Taki I, Norris JM, Erlich HA, Eisenbarth GS, Rewers M. “Rotavirus infection frequency and risk of celiac disease autoimmunity inearly childhood: a longitudinal study”. Am J Gastroenterol, 2006, 101:2333-40.
[20]  Carolina Salazar, Jennyfer M García-Cárdenas and César Paz-y-Miño. “Understanding Celiac Disease From Genetics to the Future Diagnostic Strategies”. Clinical Medicine Insights: Gastroenterology, 2017, Volume 10: 1-13.
[21]  Seah PP, Fry LL, Rossiter MA, Hoffbrand AV, Holborow EJ. “Anti-reticulin antibodies in childhood celiac disease”. Lancet, 1971, 2: 681-682.
[22]  Chorzelski TP, Sulej J, Tchorzewska H, Jablonska S, Beutner EH, Kumar V. “IgA class endomysium antibodies in dermatitis herpetiformis and coeliac disease”. Ann N Y Acad Sci, 1983, 420: 325-334.
[23]  Ladinser B, Rossipal E, Pittschieler K. “Endomysium antibodies in coeliac disease: an improved method”. Gut, 1994, 35:776-778.
[24]  Corrao G, Corazza GR, Andreani ML, Torchio P, Valentini RA, Galatola G, Quaglino D, Gasbarrin G, di Orio F. “CELIAC DISEASE PATHOGENESIS 241 screening of coeliac disease: choosing the optimal procedure according to various prevalence values”. Gut, 1994, 35: 771-775.
[25]  Lawrence R. Schiller, Darrell S. Pardi and Joseph H. Sellin, Chronic Diarrhea: Diagnosis and Management, Clinical Gastroenterology and Hepatology 2016.
[26]  Lacy BE, Mearin F, Chang L. “Bowel disorders. Gastroenterology”. 2016, 150:1393-1407.
[27]  Gebreweld A, Bekele D, Tsegaye A. “Hematological profile of pregnant women at St. Paul's Hospital Millennium Medical College”. Hematol, 2018, 18:15.
[28]  Needs T, Lynch DT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 23, 2018. Beta Thalassemia.
[29]  Farashi S, Harteveld CL. “Molecular basis of α-thalassemia. Blood Cells Mol”. 2018, 70:43-53.
[30]  Warner MJ, Kamran MT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 14, 2018. Anemia, Iron Deficiency.
[31]  Oostdijk W, Grote FK, de Muinck Keizer-Schrama SM, Wit JM. “Diagnostic approach in children with short stature”. Horm Res, 2009; 72:206-17.
[32]  Savage M.O, Backeljauw P.F, Calzada R, Cianfarani S, Dunkel L, Koledova E, Wit J.M, Yoo H.-W. “Early Detection, Referral, Investigation, and Diagnosis of Children with Growth Disorders”. Horm Res Paediatr 2016, 85:325-332.
[33]  David J Hunter and Philip N Sambrook, Bone loss: Epidemiology of bone loss, Arthritis Res. 2000; 2(6): 441-445.
[34]  Zegers-Hochschild F, Adamson GD, de Mouzon J. “International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology”. Fertil Steril, 2009, 92(5):1520-1524.
[35]  Meera Sandhu, Shweta Gulia, Mehak Nagpal and Vinod Sachdev, Circular Enamel Hypoplasia: A Rare Enamel Developmental Disturbance in Permanent Teeth, J Clin Diagn Res. 2014 Aug; 8(8): ZD39-ZD40
[36]  Nalluri, R; Harries, M. “Alopecia in general medicine”. Clinical Medicine. 2016, 16 (1): 74-8.
[37]  McElwee, K. J.; Shapiro, J. S. "Promising therapies for treating and/or preventing androgenic alopecia". Skin Therapy Letter, 2012, 17 (6): 1-4.
[38]  Leavitt, M. “Understanding and Management of Female Pattern Alopecia". Facial Plastic Surgery. 2008, 24 (4): 414-427.
[39]  Scully C, Porter S. Oral mucosal disease: Recurrent aphthous stomatitis. Br J Oral Maxillofac Surg. 2008; 46: 198-206.
[40]  Van de Wal Y, Kooy YM, van Veelen P. “Glutenin is involved in the glutendriven mucosal T cell response”. Eur J Immunol, 1999, 29: 3133-9.
[41]  Molberg O, Solheim Flaete N, Jensen T. “Intestinal T-cell responses to highmolecular-weight glutenins in celiac disease”. Gastroenterology, 2003, 125:337-44.
[42]  Dewar DH, Amato M, Ellis HJ. “The toxicity of high molecular weight glutenin subunits of wheat to patients with coeliac disease”. Eur J Gastroenterol Hepatol, 2006, 18:483-91.
[43]  Vader LW, Stepniak DT, Bunnik EM. “Characterization of cereal toxicity for celiac disease patients based on protein homology in grains”. Gastroenterology, 2003, 125:1105-13.
[44]  Shan L, Molberg O, Parrot I. “Structural basis for gluten intolerance in celiac sprue”. Science, 2002, 297:2275-9.
[45]  Hausch F, Shan L, Santiago NA. “Intestinal digestive resistance of immunodominant gliadin peptides”. Am J Physiol Gastrointest Liver Physiol, 2002, 283: G996-1003
[46]  Matysiak-Budnik T, Moura IC, Arcos-Fajardo M. “Secretory IgA mediates retrotranscytosis of intact gliadin peptides via the transferrin receptor in celiac disease”. J Exp Med, 2008, 205: 143-54.
[47]  Muegge BD, Kuczynski J, Knights D. “Diet drives convergence in gut microbiome functions across mammalian phylogeny and within humans”. Science, 2011, 332:970-4.
[48]  Forsberg G, Fahlgren A, Horstedt P. “Presence of bacteria and innate immunity of intestinal epithelium in childhood celiac disease”. Am J Gastroenterol, 2004, 99:894-904.
[49]  Tjellstrom B, Stenhammar L, Hogberg L. “Gut microflora associated characteristics in first-degree relatives of children with celiac disease”. Scand J Gastroenterol, 2007, 42: 1204-8.
[50]  Sanchez E, Donat E, Ribes-Koninckx C. “Intestinal Bacteroides species associated with coeliac disease”. J Clin Pathol, 2010, 63:1105-11.
[51]  Cinova J, De Palma G, Stepankova R. “Role of intestinal bacteria in gliadininduced changes in intestinal mucosa”: study in germ-free rats. PLoS One 2011; 6:e16169.
[52]  Losowsky MS. “A history of coeliac disease”. Dig Dis, 2008, 26: 112-120.
[53]  Dicke WK, Weijers HA, Van de kamer JH. “Celiac disease. II. The presence in wheat of a factor having a deleterious effect in cases of coeliac disease”. Acta Paediatr, 1953, 42: 34-42.
[54]  Fasano A, Catassi C. “Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum”. Gastroenterology, 2001, 120: 636-651.
[55]  Assimakopoulos SF, Papageorgiou I, Charonis A. “Enterocytes’ tight junctions: From molecules to diseases”. World J Gastrointest Pathophysiol, 2011, 2: 123-137
[56]  Cataldo F, Montalto G. “Celiac disease in the developing countries: a new and challenging public health problem”. World J Gastroenterol, 2007, 13: 2153-2159.
[57]  Catassi C, Doloretta Macis M, Rätsch IM, De Virgiliis S, Cucca F. “The distribution of DQ genes in the Saharawi population provides only a partial explanation for the high celiac disease prevalence”. Tissue Antigens, 2001, 58: 402-406.
[58]  Trynka G, Wijmenga C, van Heel DA. “A genetic perspective on coeliac disease”. Trends Mol Med, 2010, 16: 537-550.
[59]  Romanos J, van Diemen CC, Nolte IM, Trynka G, Zhernakova A, Fu J, Bardella MT, Barisani D, McManus R, van Heel DA, Wijmenga C. “Analysis of HLA and non-HLA alleles can identify individuals at high risk for celiac disease”. Gastroenterology, 2009; 137: 834-840, 840.e1-3.