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Celiac disease, also known as gluten-sensitive enteropa- thy, nontropical sprue, and celiac sprue, describes a patho-physiologic state in which patients are intolerant of cer-tain amino acid sequences found in the prolaminfraction of wheat, rye, and barley (gliadin, secalin, andhordein, respectively). 1 As such, the disease results in immunologically mediated lesions of the small intestinesand subsequent malabsorption because of a toxic reac-tion. 2 As noted in this case study, the incidence of the dis- ease is much higher than once thought, even in coun-tries where it was originally considered rare, includingthe United States. 3,4 The disease is the most common genetic disease among Europeans, 5 and thus persons in North America of European ancestry may be susceptibleto celiac disease. Given its common nature and the de-bilitating morbidity, mortality, and possible severe com-plications (eg, osteoporosis, lymphoma, anemia) associ-ated with the disease, primary care physicians mustmaintain a high index of suspicion for the disorder inpatients whose initial symptoms include gastrointestinaldisturbances and chronic diarrhea. 6 Unfortunately, many patients first present with atypical celiac disease,which can result in the disease being undiagnosed ormisdiagnosed in as many as 60% of cases.