The alpha glandin fraction of the wheat gluten is toxic to small bowel mucosal cells and the damaged mucosal cells shed into the intestinal lumen. Loss of villi and major reduction of the mucosal-absorbing surface then takes place.
Additional changes take place in subepithelial structures.
This disease may be symptomatic or asymptomatic, yet the physiologic changes that lead to future pathology are noted as taking place in infancy and young adulthood. As time goes by, mal-absorbtion takes place and symptoms are recognized. Iron-deficiency anemia develops and the patient begins to pass bulky, malodorous stools and suffers painful bloating. These and other symptoms are secondary to deficiency states. The only fully accepted treatment for this condition is gluten-free diet for life, hence the great importance of making an accurate diagnosis before instituting treatment.