Celiac disease is caused by sensitivity to gluten in cereal products Clinical manifestations include weight loss, weakness, and diarrhea with pale, bulky, frothy, foul-smelling stools. In children, it is also characterized by growth retardation and general failure to thrive. It is more common in patients with Type I diabetes mellitius. Diagnosis involves documentation of malabsorption, small intestinal biopsy demonstrating blunting of small intestinal villi, the presence of Ig-A endomysial and anti-tissue transglutaminase antibodies, and clinical improvement and restoration of normal intestinal morphology on a gluten-free diet. Incidence increases in association withhuman leukocyte antigens (HLAs) HLA-B8 and HLA-DW3. This finding and the presence of antibodies directed against gliadin (a glycoprotein component of gluten) and transglutaminase suggest that both genetic and immune-mediated mechanisms may be involved. These antibody tests may also be used for screening prior to definitive diagnosis by biopsy. Enteropathy-type t-cell lymphoma develops in a subset of patients. 2. Other malabsorption syndromes include tropical sprue, Whipple disease, disaccharidase deficiency, abetalipoproteinemia, and intestinal lymphangiectasia. Malabsorption can also be caused by pancreatic insufficiency.