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 If you have chronic diarrheas gases,  abdominal pain, weight loss,  dermatitis, perhaps you have the Celíaca disease.

Definition
Celiac disease is a chronic autoimmune disease triggered by gluten exposure in genetically predisposed individuals. It is characterized by an abnormal immune response in the small intestine that leads to damage to the intestinal villi, with symptoms that can extend beyond the digestive system.
Gluten and the Five Main Grains
Gluten is a protein complex present in the following grains:
Grain Contains Gluten Notes
Wheat Yes Main source;  Includes varieties such as spelt, kamut, and farro
Barley Yes Contains hordein
Rye Yes Contains secalin
Spelt Yes An ancient type of wheat, not suitable for celiacs
Triticale Yes A hybrid between wheat and rye
Traditional beer: Contains gluten, as it is usually made with malted barley. Only certified gluten-free beers are safe.
Pathophysiology
1. Genetic predisposition: HLA-DQ2 and/or HLA-DQ8 present in 95–98% of cases.
2. Exposure to gluten: Gliadins and other prolamines cross the intestinal barrier.
3. Immune response: T cell activation, cytokine release, and production of anti-tissue transglutaminase (anti-TTG), anti-endomysial, and anti-gliadin antibodies.
4. Villous atrophy: Decreased absorptive surface area → malabsorption.
Symptoms and clinical manifestations
1. Classic gastrointestinal symptoms
Chronic diarrhea
Steatorrhea
Weight loss
Abdominal pain
Floating
Nausea and vomiting
2. Extraintestinal manifestations
Many patients present with non-gastrointestinal symptoms or are even asymptomatic (silent form).
A. Cutaneous
Dermatitis herpetiformis: Pruritic lesions on the elbows, knees, and buttocks.
Psoriasis and other associated inflammatory eruptions.
B. Neurological and Psychiatric
Ataxia, Peripheral Neuropathy
Chronic Migraine
Attention Deficit, Anxiety, Depression
C. Hematologic
Refractory Iron Deficiency Anemia
Thrombocytopenia
D. Endocrine
Associated with other autoimmune diseases:
Type 1 Diabetes
Hashimoto’s Thyroiditis
Addison’s Disease
E. Bone
Osteopenia and Early Osteoporosis
Fragility Fractures
F. Gynecologic
Infertility
Recurrent Miscarriages
Late Menarche
G. Liver
Elevated Transaminases
Associated Autoimmune Hepatitis
Diagnosis
1. Serology
Anti-transglutaminase IgA (anti-TTG)
Anti-endomysial IgA  (EMA)
Antigliadin antibodies (less specific)
Simultaneous dose of total IgA (to rule out deficiency)
2. Duodenal biopsy
Classic pattern: villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis (Marsh classification)
3. Genetics
HLA-DQ2/DQ8: useful to exclude the disease if negative
> Important: The patient must be consuming gluten at the time of the study. A previous gluten-free diet may cause false negatives.
Management
1. Strict, lifelong gluten-free diet
Total exclusion of wheat, barley, rye, spelt, and triticale
Monitor for cross-contamination
Avoid processed foods not certified as “gluten-free”
2. Nutritional education
Label reading
Safe alternatives: rice, quinoa, corn, amaranth, buckwheat, millet
3. Supplementation
Iron, calcium, vitamin D, B12, and folic acid, depending on deficiency
4. Follow-up
Regular clinical and laboratory evaluation
Serological antibody monitoring
Periodic bone densitometry
Nutritional reassessment
Celiac disease as a systemic inflammatory disorder
Although it originates in the intestine, celiac disease is an inflammatory process  Multisystemic:
Causes chronic, low-grade systemic inflammation.
Promotes persistent immune activation.
It is associated with other autoimmune and inflammatory diseases.
This phenomenon is reflected in extraintestinal manifestations and an increased risk of:
Intestinal T-cell lymphoma (in untreated cases)
Coexisting autoimmune diseases
Growth failure in children
Conclusion
Celiac disease is much more than a food intolerance. It is a systemic autoimmune disease, with a wide variety of clinical presentations and a profound impact if not properly diagnosed and treated. The only effective treatment is a strictly gluten-free diet, which not only improves symptoms but also prevents long-term complications.
Raulayalamd@mydoctoroncall.com