Discuss the causes, symptoms and dietary management of celiac disease.

1. 1 · Open in two lines. Celiac disease is an autoimmune disease in which gluten damages the villi of the small intestine. A lifelong gluten-free diet is the only treatment.
2. 2 · Draw the villi. [Sketch: normal tall villi vs flattened villi in celiac disease]
3. 3 · Causes and symptoms.
   • Gluten + genes (HLA-DQ2/DQ8) + immune response.
   • Diarrhoea, steatorrhoea, weight loss, anaemia, poor growth.
4. 4 · Diagnosis. tTG antibody blood test and intestinal biopsy while on gluten.
5. 5 · Diet principles. No wheat, barley, rye; oats only if pure; high energy and protein; limit lactose and fat at first; iron, folate, calcium, vitamin D.
6. 6 · Allowed foods, hidden gluten and a menu. Rice, millets, pulses, milk, eggs; hidden gluten in malt, hing, sauces; one-day menu.
7. 7 · Close in one line. On a strict gluten-free diet the villi heal and the patient leads a normal life.

Scoring tip: Hidden gluten and cross-contamination are what separate an average answer from a top one; always include them.