Gut Instincts: A Clinician's Handbook of Digestive and Liver Diseases

Eric Esrailian, MD, MPH

Chapter 14: Celiac Disease (continued)

Wilfred M. Weinstein, MD

This chapter takes a “just the facts” approach to the most important aspects of the diagnosis and management of celiac disease. There are two diagnostic criteria: (1) a severe “flat” (Marsh 3) lesion exhibiting villous atrophy of the small intestinal mucosa; and (2) a clinical, biochemical (and histological) response to a gluten-free diet. Gluten is the wheat protein of wheat, barley, and rye. Gliadin is an alcohol-soluble fraction of gluten that contains most of the toxic components. The “flat” histological lesion has absent villi and increased numbers of…