CELIAC DISEASE
Diagnostic Image Compendium
Presented by Gutsy Overu
BIOL 218 Human
Anatomy
INTRODUCTION
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The purpose of this compendium is to explain what celiac disease is and to illustrate normal vs.
pathological intestines and villi
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Celiac disease is an inflammatory condition of the small intestine, induced by gluten
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Gluten is the term for the storage proteins of wheat. The alcohol-soluble fraction, called gliadin, has
been most studied, but most of all gluten proteins are likely to be toxic in celiac disease
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Celiac disease is very common, one of the most common inherited diseases that physicians can
encounter. Originally considered to be a rare disease of childhood, it is now recognized
predominantly as a disease of adults
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Overall, it is considered to occur in about 1 per 250 individuals. Most recent figures are 1 per 133 in
USA, 1 per 122 in Northern Ireland, 1 per 99 Finnish school children and 1 per 100 in western
England, which indicate it occurs in about 0.5 to 1% of those of European descent
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There are other factors apart from gluten that can contribute to the development of celiac disease.
Some of the factors are the timing of the first ingestion of gluten in childhood and the amount of
gluten, whether breast feeding occurs and whether other members of the family have celiac disease.
Smoking also influences the onset of celiac disease.
WHAT IS CELIAC
DISEASE?
What is celiac disease?
Celiac disease is an
inflammatory condition of
the small intestine, induced by
gluten. It has diverse clinical
manifestations that resemble a
multi-systemic disorder rather
than a primary intestinal
disease. Originally considered
a rare disease of childhood,
celiac disease is, however,
now recognized as a common
condition that may be
diagnosed at any age. Other
terms for celiac disease
include gluten sensitive
enteropathy and non-tropical
sprue.
http://3.bp.blogspot.com/_PC3aIMjVWm8/SRVtnmHBGII/AA
AAAAAAAso/EC-dMr7gTcs/s400/villi.jpg
SYMPTOMS
Clinical Presentation
The clinical manifestations of celiac disease vary
markedly by the age of the patient, the duration
and extent of disease, and the presence of
extraintestinal pathology (TABLE 2).1
Depending on the features at the time of
presentation and taking into account the
histological and immunologic abnormalities at
the time of diagnosis, celiac disease can be
divided into the following three clinical forms:
classic (typical), atypical, and silent
(asymptomatic).1
Significance of celiac disease
Symptomatic celiac disease is associated with a
considerable amount of illness and morbidity due
to chronic gastrointestinal symptoms and
malabsorption of nutrients, weight loss,
metabolic bone disease, anemia and general
debility. Celiac disease results in an increased risk
of the development of various malignancies
including lymphoma at any site, not only the
small intestine.
http://www.uspharmacist.com/CMSImagesContent/20
08/12/USP0812%20Celiac%20T2.jpg
VILLI DAMAGE
This figure illustrated the progression of
destruction to the intestinal villi by gluten.
When a person with celiac disease
consumes foods or uses produces that
contain gluten, his or her immune system
reacts by damaging the small intestine and
the minute, fingerlike protrusions that line
the small intestine, called villi, are
damaged or destroyed. Normally villi
permit nutrients from food to be absorbed
into the bloodstream. If the villi are not
healthy or have been destroyed, a person
become malnourished regardless of the
quantity of food eaten. This villi damage
can also lead to lactose intolerance.
http://www.my-health-and-wellnesscoach.com/images/villi.JPG
ENDOSCOPY
Endoscopic and biopsy findings in patients
with and without celiac disease. (A) Highdefinition endoscopic photo of normal small
intestine. The villi are clearly visible with no
evidence of atrophy or scalloping of the
folds. (B) Biopsy specimen of normal small
intestine (hematoxylin-eosin; original
magnification, × 100). (C) PillCam image of
small intestine in a patient with celiac
disease, showing scalloping of the mucosal
folds (arrows) characteristic of a
malabsorption pattern. There is also
evidence of villous atrophy compared with
normal. (D) Biopsy specimen of small
intestine in a patient with celiac disease
(hematoxylin-eosin; original magnification,
× 100). Note the loss of villous architecture.
http://www.aafp.org/afp/20071215/af
p20071215p1795-u3.jpg
MUCOSAL BIOPSY
Small-intestinal mucosal biopsy.
(A and B) Small-intestinal mucosal biopsy viewed through a dissecting microscope. The normal biopsy
(A) shows numerous surface villi, whereas a biopsy from an individual with CD and total villous atrophy
shows, in place of the villi, numerous surface openings to underlying crypts and surface ridges (B). (C)
H&E-stained section of a normal small-intestinal mucosal biopsy. Original magnification, ×400. (D)
H&E-stained section of a small-intestinal mucosal biopsy from an individual with CD and total villous
atrophy. Original magnification, ×400. All panels reprinted with from Gastroenterology (1) with permission
from the American Gastroenterological Association.
http://www.jci.org/articles/view/30253/files/JCI0730253.f1/medium
BIOPSY
The diagnosis of celiac disease
requires finding characteristic changes
in a small intestinal biopsy, together
with clinical and/or histologic
improvement on a gluten-free diet
.Biopsy is recommended to establish
the diagnosis because the blood tests
only suggest the presence of the
disease. In addition, the disease is life
long. Diagnosis requires the patient to
adhere to the diet throughout their
life. While it may not easy to control a
small child’s diet, as they grow older
they need to understand the disease,
believe they do have the disease and
treat it themselves. Documentation of
the disease by biopsy reinforces the
diagnosis. Studies have shown
adherence to the diet is greatest in
those who underwent biopsy
http://depts.washington.edu/drrpt/2
003/stories/researchpics/villi.jpg
TISSUE STAIN
Figure 1.
Microscope views of tissues
taken from the small intestine
by biopsy. At left are normal
villi (fingerlike projections
extending from the surface).
Figure 2.
At right, in tissue from a
celiac patient, the villi have
flattened and disappeared.
Figure 1.
Figure. 2
http://z.about.com/d/celiac
disease/1/0/0/-/-//VilliAtrophy.jpg
WHERE DO WE FIND
GLUTEN?
http://www.isletsofhope.com/pic/ZZPic%2
0celiac-sprue-foods-to-avoid.jpg
CONCLUSIONS
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Adherence to a gluten-free diet remains the mainstay of therapy for celiac disease.

Although a gluten-free diet seems simple theoretically, the diet can be difficult for some
patients to adhere to. The most common reasons for lack of response are poor
compliance and inadvertent gluten ingestion.

All patients with celiac disease should be reevaluated periodically. The evaluation
should include assessment of growth, assessment of GI and other symptoms associated
with celiac disease, and the individual patient's understanding of and compliance with
the gluten free-diet.

The most useful website for correct and through information pertaining to this disease:
http://www.uspharmacist.com/CMSImagesContent/2008/12/USP0812%20Celiac%2
0T2.jpg

A follow up compendium that would add to the understanding of celiac disease would
be research on various other autoimmune diseases.
REFERENCES
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Slide 3- Diagram of intestinal villi
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Slide 4- Symptoms chart
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http://depts.washington.edu/drrpt/2003/stories/researchpics/villi.jpg
Slide 9- Histological slide of villi
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http://www.jci.org/articles/view/30253/files/JCI0730253.f1/medium
Slide 8- Biopsy of intestinal villi
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http://www.aafp.org/afp/20071215/afp20071215p1795-u3.jpg
Slide 7- Small intestine mucosal biopsy
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http://www.my-health-and-wellness-coach.com/images/villi.JPG
Slide- 6- Endoscopy
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http://www.uspharmacist.com/CMSImagesContent/2008/12/USP0812%20Celiac%20T2.jpg
Slide 5- Villi Damage
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http://3.bp.blogspot.com/_PC3aIMjVWm8/SRVtnmHBGII/AAAAAAAAAso/EC-dMr7gTcs/s400/villi.jpg
http://z.about.com/d/celiacdisease/1/0/0/-/-/-/VilliAtrophy.jpg
Slide 10- Where is Gluten?
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http://www.isletsofhope.com/pic/ZZPic%20celiac-sprue-foods-to-avoid.jpg