Celiac Disease
M. Stephen Murphy MB BSc MRCP1
W. Allan Walker MD2
1 Instructor of Pediatrics, Harvard Medical School, Member of Combined Program in Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, MA 02115
2 Chief, Combined Program in Pediatric Gastroenterology and Nutrition, Harvard Medical School (Children's Hospital and Massachusetts General Hospital), Boston, MA 02115
Celiac disease is a disorder characterized by a permanent sensitivity to gluten, such that its presence in the diet induces an enteropathy. Exposure of susceptible individuals to gluten-containing foods causes small intestinal mucosal injury associated with malabsorption of variable severity. The association between the occurrence of malabsorption and the presence of wheat or rye in the diet was first recognized by Dicke in 1950. Subsequently, barley was also shown to be toxic. The role of oats in producing disease remains controversial, but rice and maize are known not to cause disease.
EPIDEMIOLOGY
Celiac disease is one of the most frequent causes of malabsorption during childhood, with prevalence rates of between 1:500 and 1:3000 commonly quoted in the literature. Although the exact prevalence in any particular region is difficult to determine, marked geographical variations do appear to exist. A preyalence rate of 1:300 has been reported in western Ireland. Similarly, celiac disease is reported more frequently in patients from European countries than from North America. There is some evidence that the incidence may also be changing. Based on studies from the United Kingdom, it has been suggested that the incidence of childhood celiac disease may have been declining in recent years, following a peak in the early 1970s.
