Coeliac Disease
An immune reaction to dietary gluten that flattens the small-bowel villi, so the clinical picture is the predictable consequence of losing absorptive surface, and the treatment is simply removing the trigger.
First principles
Coeliac disease is an immune attack on the small-bowel lining triggered by gluten
In genetically susceptible people (HLA-DQ2/DQ8), the enzyme tissue transglutaminase modifies gluten peptides so they bind strongly to these HLA molecules and are presented to T cells. The resulting T-cell-driven immune response is directed against the small-intestinal mucosa, producing chronic inflammation with intraepithelial lymphocytes, crypt hyperplasia and villous atrophy, the key lesion. The disease is therefore not an allergy or an enzyme deficiency but an autoimmune-like reaction whose target happens to be the absorptive surface of the gut.
Educational content pending clinical review. Not medical advice.