Coeliac disease: a graft-versus-host-like reaction localised to the small bowel wall?

In coeliac disease, gluten, or one of its fractions, combines with a gut-wall macrophage or lymphocyte to form a lymphoid cell which is recognised by the host as foreign. It is proposed that this cell, rather than being eliminated as the target of a cell-mediated attack by the host, becomes autonomous and initiates a graft-versus-host (GvH)-like reaction. The reaction is largely confined to the gut wall and its associated lymphoid tissue. The severe cachexy and the peripheral lymph-node and splenic atrophy may be explained as features of chronic GvH disease. or a "runting" syndrome. Untreated coeliac disease may lead to lymphomatous transformation indistinguishable from the lymphoma of experimental chronic GvH disease