Celiac disease (CD) is a common autoimmune disorder, induced by the intake of gluten proteins found in wheat, barley and rye. Contrary to common beliefs, this disorder is a systemic disease with different manifestations, rather than merely a pure digestive alteration. CD is closely associated with genes that code HLA-II antigens, mainly DQ2 and DQ8 classes. Previously, CD was considered to be a rare childhood disorder, but it is actually considered a frequent condition and can present at any age. Tissue  transglutaminase (tTG) appears to be an important component of this disease, both in its pathogenesis and its diagnosis and follow up. Active CD is characterized by intestinal and/or extra-intestinal symptoms, villous atrophy and crypt hyperplasia, and strongly positive anti-endomysial antibody or tTG autoantibodies. The duodenal biopsy is considered to be the “gold standard” for diagnosis. Occasionally, it results in false-negative results because of patchy mucosal changes and that, in some patients, mucosal villous atrophy is more severe in the proximal jejunum which cannot be reached by routine endoscopes. Sometimes, the presentation of CD is with iron deficiency anemia, osteoporosis, dermatitis  herpetiformis, persistent chronic hypertransaminasemia of unknown origin and neurologic disorder. The association of CD and endocrine diseases, autoimmune disorders and various types of cancer is known. Treatment of CD is a strict, life-long gluten-free diet. Gluten-free diet results in remission of most symptoms.

Introduction: On one hand the prevalence of Irritable Bowel Syndrome (IBS) ranges from 4 to 12 percent in the community; on the other hand, Celiac disease is prevalent in 4% of the IBS patients. Regarding the fact that cereals containing gluten are routinely used in Iran, diagnosing Celiac disease in IBS patients is important for conducting the treatments. The objective of this study was to assess the frequency of Celiac in IBS patients.Materials and Methods: This study was designed as a case control prospective study. Eighty six subjects were enrolled in this study according to Rome II Criteria. The control group included healthy subjects that were checked up on a routine base. The evaluation of Celiac was done through serology exams such as Anti Gliadin and Anti Transglutaminase (IgG and IgA).Results: Thirty eight male and 48 female patients suffering from IBS with a mean age of 34±11.7 years were enrolled in this study. The case and control groups were not significantly different in terms of sex and age. Flatulence, excessive gas passing and mucus passage were the most frequent symptoms in IBS patients. Night symptoms and weight loss (alarm signs) were observed in 37% and 32%, respectively. Elevated Antigliadin Titer was evident in 22 subjects (25%) which suggests a significantly higher rate for the case group as compared to the control group (t=4.67, P=0.0001).Elevated IgG Anti Transglutaminase Titer was observed in 2 cases (2.3%) while IgA Anti Transglutaminase was not elevated in any of the IBS subjects, neither in the control group nor in the case group.Conclusion: Biopsy of small intestine can be suggested to rule out the elevated Antigliadin Titer Celiac disease in IBS patients.

Background: Until a few decades ago, Celiac disease was considered to be essentially a disease of European people and to be very rare in Middle Eastern countries. During the last two decades, having met the criteria for the WHO general screening, the advent and application of novel serological assays used to screen for Celiac disease and the use of endoscopic small bowel biopsy have led to increasing numbers of diagnoses of Celiac disease in western countries. With this new data, our knowledge on both the clinical pattern and epidemiology of Celiac disease has increased, and is now known to be a relatively common autoimmune disorder. Studies performed in different parts of the developing world have shown that the prevalence of Celiac disease in this area is similar to or even higher than those in western countries. In fact, Celiac disease is known to be the most common form of chronic diarrhea in Iran. However, contrary to common belief, Celiac disease is more than a pure digestive alteration. It is a protean systemic disease, and, with a 95 percent genetic predisposition, has a myriad of symptoms including gastrointestinal, dermatological, dental, neurological and behavioral that can occur at a variety of ages. Monosymptomatic, oligosymptomatic, atypical (without gastrointestinal symptoms), silent and latent forms of Celiac disease have been identified. In this study we review the epidemiology of Celiac disease based on the studies performed in Iran and discuss its pathogenesis, the role of antibodies in the diagnosis of Celiac disease and the importance of its diagnosis and treatment in Iran.