Celiac disease is a permanaent sensitivity to gluten in genetically susceptible individuals.

the disease is an immunologically mediated small intestinal enteropathy.The mucosal lesions suggest both cellmediated and humoral immunological over stimulation.call-mediated mechanism have a key role in the induction of mucosal damage.There is a strong evidence of association with dermatitis herpetiforms,dental enamel defects,type 1 diabetes,IgA deficiency ,auto immune thyroiditis,DOWN SYNDROME,Turner,s syndrome and WILLIAM SYNDROME.The major genetic association of celiac disease is with genes and gene products of the major histo computability complex locus on chromosom e6. CLINICAL PRESENTATION The clinical presentation vary with age of the atient,the duration and extent of disease, and the presence of ectra intestinal complications.The classic form of CD in children consists of gastro intestinal symptoms starting between 6 an d 24 months of age after the introduction of wheat(gluten) in the diet.Infants and young children typically present with chronic diarrhea,anorexia,abdominal distention,abdominal pain,poor weight gain or weight loss an vomitting .Older children usually present with diarrhea,nausea,and vomiting,abdominal pain,bloating,weight lossa and constipation. NONGASTROINTESTINAL MANIFESTATIONS Extraintestinal symptoms are more common in children who present late.In these children,short stature and iron deficiency anemia resistant to oral iron supplementation are the commonest presentation.There may be associated dermatitis herpetiformis,dental enamel hypoplasia,osteopenia,delayed puberty,hepatitis DIAGNOSIS The iinitial work up of these children involves complete hemogram,serum chemistry and tests measuring intestinal absorption such as d-xylose absorption,fecal fat excretion.Diagnostic evaluation specific to the CD include serologiiical tests and histopathological changes in intestinal mucosa. SEROLOGICAL TESTS Commercially available tests include anti gliadin IgA and IgG.anti reticulin IgA,antiendomysium IgA and anti tissue transglutaminase IgA antibodies. INTESTINAL BIOPSY AND HISTOPATHOLOGY For confirmation of the diagnosis of CD, intestinal biopsy is required in all cases.As the histologic changes in CD may be patchy,it is recommended that multiple biopsy specimens be obtained from the second or more distal part of the deudonem.There is a good evidence that villous atrophy is a characteristic histopathologic feature of CD,but there can be infiltrative changes in the submucosa.The two requirements mandatory fro the diagnosis of celiac disease are

Most newly diagnose d children willltolerate ingestion of lactose particularly in moderate amounts.Rice an d maize are noon toxic and they act as wheat substitutes.Young ch ildren with more severe disease may benefit from an initial lactose free diet.A GFD for life remains the only scientifically proven treatment available fro symptomtamatic individuals with CD.It is recommended that treatment can be started only after the diagnosis has been confirmed by intestinal biopsy.therefore dietary lactose restriction is not usually necessary.a positive serological test tha t reverts to negative after treatment witih a strict gluten free diet in such cases is furthet supportive evidence fro the diagnosis of CD.In patients with selective IgA deficiency serological diagnosis will be difficult..1) Villous atrophy with hyperplasia of the crypts and abnormal surface epithelium while the patient is eatin adequate amount o f glutens 2) A full clinical histological remission after withdrawal of gluten from the diet. MANAGEMENT Treatment with a strict gluten free diet is recommended for all symptomatic children with characteristic intestinal histopathologic abnormalities and alsoasymptomatic children wih a condition associated with CD and characteristic histologic findings on small intestinal biopsy.even small amount of gluten containing grains ingested on a regular basis lead to mucosal changes on a intestinal biopsy and persistence of clinical symptoms.So in patients who are strongly suspected to be CD but regular IgA BASED MARKER IS NEGAIVE……. .