celiac disease
Enable an agent to recognise celiac disease, assess the evidence and activity attributed to it, and identify appropriate next steps while preserving diagnostic uncertainty.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise celiac disease, assess the evidence and activity attributed to it, and identify appropriate next steps while preserving diagnostic uncertainty.
Celiac disease is a chronic, immune-mediated systemic disorder in genetically susceptible individuals, triggered by dietary gluten from wheat, barley and rye and characterized by gluten-dependent small-intestinal injury and associated autoantibodies.
It can be Assess whether recorded evidence supports a celiac disease assertion under a named diagnostic framework.; Identify missing evidence and testing conditions that limit interpretation.; Distinguish celiac disease from relevant alternative explanations and record unresolved overlap.; Track symptoms, serology, nutritional consequences and intestinal recovery as separate outcomes.; Identify when persistent symptoms or suspected complications warrant clinician reassessment.; Link disease-specific management constraints to dietary support and care plans without equating those plans with the disease..
Distinguishing features
Distinguish celiac disease from wheat allergy by the disease mechanism and diagnostic evidence; a wheat-associated reaction alone does not identify celiac disease.
Distinguish celiac disease from non-celiac gluten sensitivity by evaluating celiac-specific serology and intestinal evidence through an applicable diagnostic pathway; symptom improvement after gluten avoidance alone is insufficient.
Distinguish genetic susceptibility from established disease: a compatible HLA result supports susceptibility but does not independently establish celiac disease.
Distinguish celiac enteropathy from other causes of villous injury by combining histology with serology, exposure history and assessment of alternative explanations.
Distinguish controlled celiac disease from absence of disease: improvement during gluten avoidance does not by itself invalidate an established diagnosis.
Scope
+ Celiac disease identity, terminology and versioned classification mappings
+ Gluten exposure, genetic susceptibility and immune-mediated small-intestinal injury
+ Diagnostic evidence, testing conditions and guideline-specific confirmation pathways
+ Intestinal and extraintestinal manifestations, disease activity and complications
+ Disease-specific dietary management, response assessment and unresolved symptoms
- The patient's complete health record and unrelated conditions
- Appointments, referrals and other episodes of care
- Wheat allergy and non-celiac gluten sensitivity as independent conditions
- Food product composition, certification and manufacturing processes
- Laboratory assay operation and endoscopy procedure specifications
- Population-wide nutrition policy and general dietary planning
Characteristics
- Diagnostic assertion status
- suspected | confirmed under a named pathway | unresolved | excluded under stated conditions | historical diagnosis requiring verification Prevents symptoms, susceptibility or an undocumented historical label from being treated as confirmed disease.
- Diagnostic framework
- Issuing body, guideline title, version or year, jurisdiction and applicable age group Confirmation requirements and eligibility for pathways without biopsy depend on the framework applied.
- Gluten exposure at evaluation
- usual gluten-containing diet | reduced intake | gluten avoidance | supervised challenge | unknown; include duration and estimated intake when available Exposure conditions affect interpretation of diagnostic and follow-up evidence.
- Celiac-related serology
- Assay identity, immunoglobulin class, result, laboratory unit, upper limit of normal, date and concurrent total IgA where relevant Supports interpretation of antibody findings without assuming that assays or numerical thresholds are interchangeable.
- Duodenal histological evidence
- Sampling sites and adequacy, reported mucosal findings, grading system and version, examination date, or not obtained Makes intestinal evidence interpretable and distinguishes absent sampling from normal findings.
- HLA susceptibility evidence
- Reported celiac-associated HLA findings, test coverage, interpretation source, or not tested Keeps susceptibility evidence separate from proof of disease and makes negative results interpretable.
- Clinical presentation
- Intestinal manifestations | extraintestinal manifestations | mixed presentation | no recognised symptoms; specify individual findings Avoids requiring gastrointestinal symptoms for recognition.
- Disease activity and response
- Separate dated assessments of symptoms, serology, nutritional status and mucosal findings; unknown where unassessed Prevents improvement in one domain from being treated as evidence that every domain has recovered.
- Population frequency estimate
- Percentage or cases per stated denominator, with population, geography, observation period, ascertainment method and source Separates screening positivity, confirmed disease and recorded diagnoses when comparing prevalence.
Also called
Where this came from
wikidata · CC0 1.0
Also registered as vr.tr.celiac-disease
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 18 findings · 30 questions.
Celiac identity and boundaries Establishes what disease concept an assertion refers to and how it differs from adjacent gluten-related conditions.
Gluten-associated symptoms, genetic susceptibility and established celiac disease must not collapse into a single label.
Terminology and classification
Connects the registry concept to sourced definitions and versioned clinical terminology.
Versioned disease identity
Record the definition and classification mapping used, including whether a code denotes the disease, a manifestation or a diagnostic context.
- Which authoritative definition establishes the intended meaning of celiac disease for vr.tr.celiac-disease? definition
- Which ICD-10 variant, ICD-11 release and SNOMED CT edition supply verified mappings, and what is each mapping's scope? provenance
Adjacent condition boundaries
Separates the disease from similar presentations and from records asserting that it exists.
Disease versus associated labels
Distinguish celiac disease from wheat allergy, non-celiac gluten sensitivity, susceptibility and the diagnosis event.
- What evidence distinguishes this assertion from wheat allergy or non-celiac gluten sensitivity? boundary
- Does the record describe the disease, a provisional diagnostic assertion, genetic susceptibility or an episode of care? boundary
Gluten, susceptibility and injury Represents the relationship between relevant exposure, host susceptibility and intestinal immune injury.
Exposure and susceptibility explain disease context but must remain distinct from evidence confirming the condition.
Gluten exposure context
Records exposure information needed to interpret manifestations and testing.
Exposure relative to evidence
Anchor reported gluten intake or avoidance to the dates of symptoms, serology and biopsy.
- What gluten exposure or avoidance was reported before each diagnostic sample, and over what period? measurement
- If intake was reduced before testing, what clinician-directed reassessment does the applicable guideline support? action
Susceptibility and enteropathy
Distinguishes inherited susceptibility from observed immune and mucosal abnormalities.
Mechanism and evidence separation
Represent HLA findings, immune markers and intestinal injury as related but non-interchangeable evidence.
- Which reported findings concern susceptibility, which concern immune activity, and which demonstrate mucosal injury? definition
- What alternative causes could explain the observed intestinal injury, and which have been evaluated? boundary
Diagnostic evidence and confirmation Organises interpretable test results and the rules used to reach or defer a diagnosis.
Diagnostic confidence depends on assay context, sampling and eligibility for a specific confirmation pathway.
Serology interpretation
Preserves assay details and factors that affect the meaning of antibody results.
Interpretable antibody evidence
Record antibody results with reference limits, immunoglobulin context and contemporaneous exposure.
- Which assays were used, what were their results and upper limits of normal, and was total IgA assessed? measurement
- How do IgA deficiency, reduced gluten intake or discordant results affect interpretation under the cited guideline? boundary
Confirmation pathway
Connects diagnostic conclusions to biopsy evidence or documented eligibility for another accepted pathway.
Criteria-supported conclusion
Retain the applicable criteria, evidence satisfying them and unresolved reasons to defer confirmation.
- Which issuing body and guideline version govern this conclusion, and are its age and pathway eligibility requirements met? provenance
- What biopsy sampling and histology support confirmation, or which documented criteria justify a pathway without biopsy? measurement
- What further evaluation is indicated when serology, histology and clinical context disagree? action
Presentation, course and burden Describes manifestations, affected populations and changes in disease expression over time.
Celiac disease can be recognised through different manifestations, and symptoms alone do not capture its activity or burden.
Manifestations and populations
Records intestinal and extraintestinal findings and the context of population estimates.
Presentation and ascertainment
Separate observed manifestations from attributed consequences and distinguish routes of disease detection.
- Which gastrointestinal, nutritional, growth, skin or other extraintestinal findings are documented, and how is their attribution supported? measurement
- For a prevalence claim, what population, observation year and diagnostic ascertainment method produced the estimate? provenance
Longitudinal disease state
Tracks changes across clinical, biochemical and intestinal evidence without forcing a single stage label.
Activity and consequences over time
Preserve separate trajectories for symptoms, antibody results, nutritional consequences and mucosal findings.
- How have symptoms, serology, nutritional status and any repeat histology changed relative to management and exposure? measurement
- Which complications are confirmed, suspected or unassessed, and what evidence supports each status? boundary
Dietary management and reassessment Represents disease-specific management requirements and evaluation of incomplete response.
An agent must distinguish an intended gluten-free diet, actual exposure, recovery and persistent disease before suggesting next steps.
Gluten-free management
Connects dietary treatment to feasible support, exposure assessment and nutritional adequacy.
Management feasibility and follow-up
Record the prescribed approach, access barriers and evidence used to assess implementation and response.
- What dietary guidance and specialist nutritional support have been provided, and what barriers affect implementation? action
- How are inadvertent gluten exposure, nutritional adequacy and treatment response assessed without relying solely on reported symptoms? measurement
Persistent symptoms and injury
Structures reassessment when expected improvement is incomplete or new problems arise.
Nonresponse differentiation
Distinguish ongoing exposure, an uncertain original diagnosis, alternative conditions and suspected refractory disease.
- Which explanations for persistent symptoms or intestinal injury have been evaluated, and what remains unresolved? boundary
- Which criteria and specialist assessment are required before applying a refractory celiac disease label? provenance
- What documented findings warrant specialist reassessment or investigation of complications? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This is a recall-based description; no sources or terminology releases were consulted.
- Check current guideline revisions and jurisdiction-specific labeling requirements before operational use; pediatric and adult diagnostic criteria are not interchangeable.
- Potential disease and refractory subtypes require precise specialist definitions; prevalence estimates should specify population, year and ascertainment method.
- Which of these check these first hold for the sense of celiac disease this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Classical celiac disease, presenting with malabsorption
- Nonclassical celiac disease, presenting without overt malabsorption
- Asymptomatic celiac disease
- Potential celiac disease, with compatible serology but no villous atrophy
- Refractory celiac disease type I
- Refractory celiac disease type II
- Which of these kinds and varieties hold for the sense of celiac disease this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10, World Health Organization - K90.0 - Coeliac disease; record the classification version and any national modification.
- SNOMED CT - 396331005 - Celiac disease; verify terminology edition and release before operational use.
- Which of these identifiers and schemes hold for the sense of celiac disease this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- American College of Gastroenterology: 2023 clinical guideline on diagnosis and management of celiac disease.
- European Society for Paediatric Gastroenterology, Hepatology and Nutrition: 2020 pediatric diagnostic guideline, including a defined pathway for diagnosis without biopsy in selected children.
- Codex Alimentarius Commission: CXS 118-1979, Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten.
- United States Food and Drug Administration: gluten-free food-labeling requirements under 21 CFR 101.91.
- European Commission: Implementing Regulation (EU) No 828/2014 on information concerning the absence or reduced presence of gluten in food.
- Which of these standards and regulation hold for the sense of celiac disease this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical recognition of intestinal and extraintestinal disease, including presentations involving anemia, impaired growth or reduced bone density.
- Diagnostic assessment using celiac serology, total IgA and, where indicated, duodenal biopsies, interpreted in relation to gluten exposure.
- Targeted testing of higher-risk groups, including first-degree relatives and people with associated autoimmune conditions.
- Management through a sustained gluten-free diet, nutritional assessment and follow-up of symptoms, serology and intestinal recovery.
- Clinical documentation and coding that distinguish the underlying disease from a diagnostic investigation or episode of care.
- Which of these real-world use hold for the sense of celiac disease this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Reducing gluten intake before diagnostic testing can make serology and histology falsely reassuring.
- IgA deficiency can cause false-negative IgA-based serology unless accounted for.
- HLA-DQ2 or HLA-DQ8 positivity indicates susceptibility but does not establish the diagnosis.
- Unrecognized disease or continued gluten exposure can contribute to nutritional deficiencies, anemia, impaired growth and bone disease.
- Persistent symptoms require evaluation for ongoing exposure and alternative conditions; refractory disease, particularly type II, carries increased lymphoma risk.
- Which of these failure modes and hazards hold for the sense of celiac disease this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Diagnostic pathways differ between pediatric and adult guidelines and between healthcare systems, especially regarding diagnosis without biopsy.
- Food-labeling rules and the treatment of oats differ by jurisdiction; contamination with wheat, barley or rye is a practical concern.
- Reported prevalence varies with population, genetic susceptibility, gluten consumption and case-finding methods; diagnosed prevalence differs from screening-detected prevalence.
- Which of these regional variation hold for the sense of celiac disease this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Wheat allergy - An allergic response to wheat proteins, often assessed through allergy history and IgE testing, rather than the characteristic gluten-dependent autoimmune enteropathy of celiac disease.
- Non-celiac gluten sensitivity - Symptoms associated with gluten-containing foods after celiac disease and wheat allergy have been excluded; there is no established specific diagnostic biomarker.
- Irritable bowel syndrome - A disorder of gut-brain interaction that may produce similar symptoms but does not itself explain celiac-specific autoantibodies or villous atrophy.
- Dermatitis herpetiformis - A cutaneous manifestation of gluten-sensitive disease, distinguished by characteristic skin findings and granular IgA deposition on direct immunofluorescence.
- Other causes of villous atrophy - Medication effects, infections and immune disorders can mimic intestinal histology; villous atrophy alone does not establish celiac disease.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of celiac disease this model covers, and on what evidence? provenance
What the second pass must settle
- Does an existing Vercy world model already own this disease concept, requiring the registry entry to link to that publication?
- Which current authoritative diagnostic frameworks should govern the model across adult, paediatric and jurisdiction-specific settings?
- What exact ICD-10, ICD-11 and SNOMED CT mappings apply, including edition, release and distinctions involving manifestations or complications?
- How should potential celiac disease, seronegative presentations and refractory subtypes be represented while preserving this registry entry's granularity?
- Which sourced population estimates and follow-up criteria are sufficiently comparable to support prevalence and recovery assessments?