Immune-mediated destruction of villi in the proximal small bowel due to exposure to gluten, usually diagnosed in childhood, can present in adulthood with anaemia or new onset diarrhoea in adulthood

Commonest in white Europeans. Associated with other autoimmune disorders such 

as Type 1 Diabetes, IgA deficiency, Sjögren Syndrome, Rheumatoid Arthritis

Pallor, dermatitis herpetiformis (itchy rash on extensor surfaces), distended abdomen, mouth ulcers

Lethargy, steatorrhoea, diarrhoea, frothy foul smelling stool, weight loss, vitamin deficiency, iron deficiency, osteoporosis

Bloods: FBC, U&E

Auto-Antibody Screen:  Tissue Transglutamase and Anti-endomysial positive 

OGD: Duodenal biopsies show villous atrophy and crypt hyperplasia

Conservative: Gluten free diet

Medical: Steroids and immunosuppression for refractory disease

Susceptibility to GI malignancy, T-Cell lymphoma, Anaemia, Osteoporosis

70% improve within 2 weeks of a gluten free diet.