Celiac sprue is associated with

The precise mechanism of mucosal damage is unclear but immunological responses to gluten play a key role . There is a strong genetic component, with around 10% of first-degree relatives of an index case affected, and there is strong (approximately 75%) concordance in monozygotic twins. There is a strong association with human leukocyte antigen (HLA)-DQ2/DQ8. Dysbiosis of the intestinal microbiota has been identified but it is unclear if this is pathological or a response to the underlying mucosal changes Ref Davidson edition23rd pg 805