Background Celiac disease is an immune-mediated enteropathy, triggered by dietary wheat gluten and similar proteins of barley and rye in genetically susceptible individuals. It is recognized by classical clinical symptoms, features of malabsorption, and positive serology (anti-gliadin and anti-transglutaminase antibodies). The diagnosis is further supported by characteristic endoscopic and histologic features (modified Marsh classification). However, 1-2% of those with CeD will have refractory c