Celiac Disease (Gluten-Sensitive Enteropathy)

Nutrition status - malabsorption spans fat, protein, carbohydrate, vitamins, minerals and trace elements. Get a formal nutritional assessment and the recent weight trend before an elective case; a poorly controlled patient is a malnourished patient.

Anemia - order a CBC with red cell indices plus iron studies. The picture is microcytic and hypochromic. Iron-deficiency anemia carries longer hospital stays and more adverse events, so treat it in clinic, not in the holding area.

Bleeding risk - fat malabsorption depletes the fat-soluble vitamins, and vitamin K deficiency causes real bleeding. Check an INR before neuraxial or any case with meaningful blood loss; vitamin K corrects a deficiency-driven coagulopathy if you have the time.

Electrolytes - chronic diarrhea plus mineral malabsorption. Get a BMP with magnesium and calcium before induction.

Positioning - low bone mineral density predisposes to low-impact fragility fractures, classically hip and spine. Move and pad these patients deliberately.

Skin - dermatitis herpetiformis travels with celiac disease: an intensely pruritic, excoriated, blistering rash over extensor surfaces. Look before you tape, and site adhesives, ECG pads and the grounding pad on unaffected skin.

Don't confuse it with wheat allergy - celiac disease is the non-IgE-mediated response to wheat protein and will not give you intraoperative anaphylaxis. True IgE-mediated wheat allergy can be life-threatening and belongs on the allergy list separately.

Diet, not drugs - the treatment is gluten avoidance. There is no anesthetic agent to avoid and no altered drug handling; the anesthetic risk is entirely the downstream deficiency state.

Celiac disease is an autoimmune enteropathy of the small intestine driven by an inappropriate immune response to dietary gluten. Gluten exposure triggers IgA autoantibodies against tissue transglutaminase and an inflammatory attack on the duodenal mucosa that flattens the villi; diagnosis rests on duodenal biopsy taken at endoscopy, supported by serology. The damaged absorptive surface is what matters perioperatively — malabsorption spans fat, carbohydrate, protein, vitamins, minerals and trace elements. That produces iron-deficiency anemia, fat-soluble vitamin deficiency including vitamin K with its bleeding risk, low bone mineral density, and electrolyte losses from chronic diarrhea. Treatment is lifelong gluten withdrawal, and a patient on a strict gluten-free diet may absorb normally. It is not the same thing as IgE-mediated wheat allergy.