Celiac DiseaseCeliac Diseasealso known as gluten-sensitive enteropathy, spruce, or coeliac is an autoimmunedisease where the individuals impacted are allergic to gluten which is aprotein that is found in foods such as wheat, barley, rye. When someone hasCeliac Disease, the individual must abide by a strict gluten-free diet. Theintolerance to gluten causes damage to the individuals small intestine whichcauses malabsorption of nutrients. The damage to the small intestine causes diarrhea,fatigue, anorexia, stomach bloating and anemia.
EtiologyCeliac disease occurs when there isan interaction between the individual’s genes, when the individual eats foodswith gluten. The cause is that the immune system reacts with the gluten causesdamage to the small intestine which can start as an infection in thegastrointestinal system but also has hereditary components (VanMeter andHubert, 2014). The immune response to the infection or genetic issue is damageto the villi or small hair like projections within the small intestine whichhelp absorb vitamins and nutrients. When these villi are damaged, theindividual cannot receive all the nutrients regardless of their diet orlifestyle (VanMeter and Hubert, 2014).
Risk factors for celiac disease arehaving a family member with the disease, being a Type 1 Diabetic, havingchromosomal abnormalities such as Down Syndrome, having thyroid problems,colitis, Addison’s disease or Rheumatoid Arthritis. Almost all of the individuals diagnosed with Celiac disease havethe gene HLA-DQ2 or HLA-DQ8, in order to determine if these are the causes agenetic test would need to be performed (Rubio-Tapiaet al., 2013).
As noted prior, having one autoimmune disease such asRheumatoid Arthritis increases the individual’s chances of developing another. Thereis no age range for celiac disease, as many people wait several years to bediagnosed or are misdiagnosed with other gastrointestinal disorders first. Menand women are both affected by celiac disease. Individuals diagnosed withceliac disease must adhere to a strict gluten-free diet.Pathophysiological Processes Individualswith Celiac Disease have a sensitivity to various proteins known as prolamines.These individuals are unable to tolerate the alcohol-soluble component ofgluten which is the protein found in wheat, barley, rye and oats.
The grains thatthese individuals are sensitive to are known as wheat (gliadin), rye (secalin),barley (hordein), and oats (avenalin) (Rubio-Tapiaet al., 2013). The genes HLA-DQ2 or HLA-DQ8 are often tied to CD4 T cellsin the small intestine causing the destruction and inflammation of the liningtissue (Bai et al.
, 2016). Also,many individuals are deficient in IgA. The immunological response to theingestion of gluten often leads to damage in the small intestine leading tomalnutrition and malabsorption. This autoimmune disease frequently affects individualsin northern and western European decent. Due to this, patients having shortenedvilli in their small intestine due to the damage caused by gluten these individualsoften have an enzyme known as Tissue transglutaminase which is released fromthe cells that can cause the destruction (Rubio-Tapia et al., 2013).
Clinical Manifestations and Complications Celiac disease can manifest in many differentways and can occur in childhood and adulthood. A major indicator of a glutensensitivity is when infants are given cereal between ages 4-6 months (VanMeterand Hubert, 2014). Due to having so many gastrointestinal symptoms, many peoplego misdiagnosed for years or undiagnosed. When left untreated, individuals withceliac disease can have extensive damage to the small intestine. Some of thecomplications of celiac disease are other autoimmune diseases, osteoporosis dueto malabsorption of calcium, thyroid disorders and cancer.
Some of the mostcommon signs and symptoms are anemia, bloating in the abdominal region, delayedgrowth, anorexia, depression, diarrhea, teeth discoloration, fatigue, infertilityand an itchy skin rash known as dermatitis herpetiformis and fragile bones (VanMeterand Hubert, 2014).Diagnostics Although Celiac disease often goesmisdiagnosed, individuals can receive screenings such as the blood test knownas the celiac panel or tTG-IgA test which tests for celiac disease antibodies (Rubio-Tapia et al., 2013). Individuals who should be screened are children lessthan 5 years old who experience the symptoms, first-degree relatives whichmeans that the parents have the autoimmune disease or individuals with pre-exisitngautoimmune disorders such as Type 1 Diabetes.
Also, the individuals can betested for HLA-DQ2 or HLA-DQ8 gene (Bai et al., 2016). The diagnosis of celiac disease is confirmed byperforming an endoscopic biopsy of the lining of the small intestine (VanMeterand Hubert, 2014). The biopsy of the small intestinal lining will show and increasein intra-epithelial lymphocytes which is a type of white blood cell found inthe intestines (Bai et al., 2016).The biopsy will also show the shortened villi. The biopsy is then classifiedusing the Marsh Classification varying the severity of the damage in the smallintestine showing damage to the folds in the duodenum or small intestine andfissures within the mucosa. The small intestine biopsy is the only positiveconfirmation of Celiac Disease, the blood tests will show a possibility butwill not confirm the diagnosis (VanMeter and Hubert, 2014).
The doctor willalso monitor dietary compliance with a strict gluten free diet. References Bai, J. C., Ciacci, C.
, Corazza, G. R., Fried, M., Olano, C., Rostami-Nejad, M., & LeMair, A. (2016, July).
Retrieved March 11, 2017, from www.worldgastroenterology.org/UserFiles/file/guidelines/celiac-disease-english-2016.pdf Rubio-Tapia, A., Hill, I. D.
, Kelly, C. P., Calderwood, A. H., Murray, J.
A., & American College of Gastroeneterology. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. American Journal of Gastroenterology, 108(5), 656-676. doi:10.1038/ajg.
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