Celiac Disease and Gluten Sensitivity

Prim Care. 2017 Dec;44(4):693-707. doi: 10.1016/j.pop.2017.07.011.


Celiac disease is an immune-mediated enteropathy triggered by gluten that affects genetically predisposed individuals, typically causing intestinal symptoms and malabsorption. Diagnosis requires stepwise evaluation with anti-tissue transglutaminase IgA and histologic analysis of the small bowel. Strict adherence to a gluten-free diet is the primary treatment. Patients with symptoms thought to be related to gluten but without evidence of celiac disease are difficult to diagnose and treat. Consider first advising general nutritional improvements. If symptoms persist, involve a trained dietitian for restrictive diets and consider evaluation for small intestinal bacterial overgrowth or other treatments for irritable bowel syndrome.

Keywords: Celiac disease; FODMAPs; Gluten challenge; Gluten sensitivity; Gluten-free diet; Iron deficiency; Irritable bowel syndrome; Malabsorption.

Publication types

  • Review

MeSH terms

  • Celiac Disease / diagnosis
  • Celiac Disease / physiopathology*
  • Celiac Disease / therapy
  • Diagnosis, Differential
  • Diet, Gluten-Free / methods
  • Endoscopy, Gastrointestinal
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / diet therapy
  • Food Hypersensitivity / physiopathology*
  • GTP-Binding Proteins / immunology
  • Genetic Predisposition to Disease
  • Glutens / immunology*
  • HLA-DQ Antigens / immunology
  • Humans
  • Polysaccharides / immunology
  • Primary Health Care
  • Transglutaminases / immunology


  • HLA-DQ Antigens
  • HLA-DQ2 antigen
  • Polysaccharides
  • Glutens
  • transglutaminase 2
  • Transglutaminases
  • GTP-Binding Proteins