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Celiac disease is a genetically determined autoimmune disorder induced by an environmental agent, gluten. The disease involves the development of a T-cell mediated inflammatory reaction to ingested gluten in the small intestine that results in villous atrophy. The manifestations of the disease are varied. Patients may be critically ill due to a severe malabsorption syndrome or asymptomatic. The reason for the varied phenotypic expression of the disease is unclear. The mainstay of therapy is a gluten-free diet that may be a testing endeavor in this culture.