Inside Celiac Disease Quiz

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All 24 questions and answers

Part 1: The villi

What are villi?
Answer: Tiny finger-like projections that absorb nutrients. Villi are small, finger-like projections lining the small intestine. Their job is to absorb nutrients from food.
Thanks to all its folding, about how large is the inner surface of the small intestine?
Answer: About 30 square meters, roughly the floor of a small studio apartment, packed inside your belly. That surface is what absorbs your food.
The model shows a section of the duodenum. Where is the duodenum?
Answer: The first part of the small intestine, just after the stomach. The duodenum is the first part of the small intestine. Celiac damage is usually most severe in this first stretch, and it's where doctors take biopsy samples.
What happens when the villi are damaged?
Answer: They can't properly absorb iron, vitamins and other nutrients. Damaged villi can't properly absorb iron, vitamins and other nutrients. Less surface means fewer nutrients are taken in.

Part 2: What celiac disease is

What kind of disease is celiac disease?
Answer: An autoimmune disease. Celiac disease is a serious autoimmune disease. In people who are genetically predisposed, eating gluten leads the immune system to attack the lining of the small intestine and damage the villi.
Gluten is a protein found in which grains?
Answer: Wheat, rye and barley. Gluten is a protein found in wheat, rye and barley. Even small amounts, such as crumbs from a cutting board or toaster, can trigger intestinal damage.
About what share of all people carry one of the gene variants (HLA-DQ2 or HLA-DQ8) linked to celiac disease?
Answer: About 30 to 40 percent of all people carry one of them, but only about 3 percent of those carriers develop celiac disease. Almost everyone with the disease carries one.
What is the risk for a parent, child or sibling of someone with celiac disease?
Answer: 1 in 10. Celiac disease runs in families: a first-degree relative has a 1 in 10 risk. It can develop at any age once a person starts eating gluten.

Part 3: The stages of damage

What scale do pathologists use to grade the damage in a biopsy?
Answer: The Modified Marsh scale. Pathologists grade the damage on the Modified Marsh scale, from Marsh 0 (healthy) to Marsh 3c (complete villous atrophy). These are the stages on the slider in the model.
At Marsh 1, what does the pathologist see?
Answer: More immune cells in the lining, but villi that still look normal. Marsh 1 means more immune cells (lymphocytes) have moved into the surface lining while the villi still look normal. On its own, this pattern can also have other causes.
What does "villous atrophy" mean?
Answer: The villi shrink and flatten. Villous atrophy means the villi shrink and widen, then flatten. It is graded as mild (3a), marked (3b) or complete (3c), and it's the pattern seen in symptomatic celiac disease.
Which stage describes a lining that is nearly flat, with the villi gone?
Answer: Marsh 3c is complete villous atrophy: the villi are gone and the lining is nearly flat, so much of what is eaten passes by without being absorbed.

Part 4: Diagnosis

What is usually the first test for celiac disease?
Answer: A blood test for antibodies. It usually starts with a blood test for antibodies, such as tissue transglutaminase antibodies. If the tests point to celiac disease, a doctor confirms it with a biopsy.
How do doctors confirm celiac disease?
Answer: With an endoscopy that takes tiny samples from the duodenum. A thin, flexible scope passes through the mouth into the small intestine and takes several tiny samples from the duodenum. The Celiac Disease Foundation calls this biopsy the gold standard.
Should you start a gluten-free diet before being tested?
Answer: No. Starting the diet first affects the test results. Don't go gluten-free before you're tested. Starting the diet first affects the test results, so the disease can be missed.
How many biopsy samples does the Celiac Disease Foundation recommend?
Answer: At least 4 to 6. The Celiac Disease Foundation recommends at least 4 to 6 samples. A pathologist examines them under a microscope and grades them on the Modified Marsh scale.

Part 5: Treatment and healing

What is the only treatment for celiac disease?
Answer: Lifelong adherence to a strict gluten-free diet. Celiac disease can't be cured. The only treatment is lifelong adherence to a strict gluten-free diet, which lets symptoms settle and the villi heal.
The American College of Gastroenterology's guideline reports how quickly most children heal on the diet?
Answer: Within about two years. The guideline reports healing in 95 percent of children within two years of starting the diet. Children usually heal fastest.
In a Mayo Clinic study of 241 adults, about how many had a recovered lining after five years on the diet?
Answer: About two-thirds. The lining had recovered in 34 percent after two years and 66 percent after five, so about a third still had damage at five years. Adults take longer than children.
What is refractory celiac disease?
Answer: A rare form in which the damage doesn't respond to a strict gluten-free diet. Rarely, the damage doesn't respond to a strict gluten-free diet at all. This is called refractory celiac disease.

Part 6: Long-term risks

Why can untreated celiac disease lead to iron-deficiency anemia?
Answer: The damaged villi can't take in enough iron. Damaged villi can't take in enough iron, vitamins and other nutrients, which can lead to malnutrition and anemia.
Which part of the body can years of untreated celiac disease weaken?
Answer: Bones. Years of damage and poor absorption can lead to bone thinning (osteoporosis) and fractures.
The Celiac Disease Foundation puts the risk of small bowel cancers for people with celiac disease at:
Answer: About 4 times higher, and the risk of coronary artery disease about 2 times higher. Mayo Clinic also lists a higher risk of intestinal lymphoma.
In a 1999 study cited by the Celiac Disease Foundation, what happened as diagnosis came later in life?
Answer: People were more likely to also have another autoimmune condition. The later celiac disease was diagnosed, the more likely a person was to also have another autoimmune condition: 10.5 percent when diagnosed at ages 2 to 4, rising to 34 percent after age 20.

Twenty-four questions, four for each part of Inside Celiac Disease. Take them all, or pick one part. After each answer you'll see a short explanation, so you learn something even when you guess wrong.

Earn a certificate: take all six parts in one sitting and score 18 or more out of 24. Score 21 or more for Honors, and all 24 to become a Celiac Science Master.

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Every question comes from Inside Celiac Disease, where each fact links to a published source, such as the Celiac Disease Foundation, Mayo Clinic, MedlinePlus and peer-reviewed research. The full list of sources is at the bottom of that page.

This quiz is educational, not medical advice. If you think you might have celiac disease, talk to a doctor, and don't go gluten-free before you're tested: starting the diet first affects the test results.

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