Celiac disease (from Greek "koiliakos" meaning "abdominal" is an autoimmune disorder of the small intestine that occurs in genetically predisposed Pt's.
What is celiac disease?
It's where the body's cells attacks itself. Specifically, of the small intestines.
Immune reaction to a gluten protein found in wheat, but also found in other grains e.g. barley and rye, causing an inflammatory reaction
Upon exposure to gluten, an abnormal imune response may lead to the production of several different autoantibodies that can affect numerous different organs
In the small bowel, this caues an inflammatory reaction, that causes villous atrophy, which is shortening of the villi lining the small intestine, thereby affecting nutrient absorption
This affects the absorption of nutrients
Why does the body attack it's own small intestines?
Because of a gluten protein, found in wheat. It causes inflammation. This causes the lining of the small intestine, to blunt. This affects nutrients from being absorbed.
Pain and discomfort, in the GI tract
Failure to thrive (in children)
Often begins between 6mo-2yo
Non-classical Sx are the ost common especially in patients >2yo, where there are mild or absent GI Sx, systemic disease, and no obvious Sx
What happens if a gluten protein found in wheat causes the small intestine lining to blunt?
Pain and discomfort. Chronically unable to poop. Watery poop, on the other end. Vitamin deficiency. Not neough weight gain. Low red blood cell. Feeling tired. You might also see nothing.
All tests lose their usefulness if the patient is already eating a gluten-free diet. For those who have already started on a gluten-free diet, it may be necessary to performa rechallenge, with some gluten-containng food in 1 meal a day over 6 weks before repeating Ix:
Blood autoantibody tests, first line, although these are frequently negative. Its sensitivyt correlates with the degree of histological lesions
Anti-tTG (anti-transglutiminase antibodies) has a sensitivity of 99% and specificity of >90%. It should be performed 1st as it is the easier test to perform
Anti-endomysial antibodies of the IgA type can detect celiac with sensitivity and specificity of 99%
Anti-gliadin/DGP antibodies (antibodies against deamidated gliadin peptides), which is better than anti-endomysial and anti-transglutimase antibodies in kids <2yo
Anti-reticulin, although it is not accurate enough for routine Dx usage
Endoscopy/gastroscopy and intestinal biopsy, although many people have only minor intestinal changes with normal villi
Specific genetic testing
Strict life long gluten-free diet, which leads to recovery of the intestinal mucosa, improves Sx, and reduced risk of developing complications. It includes prohibition of:
A small minority of Pt's w/ celiac ALSO react to oats, because of cross-contamination w/ other grains in the field, or distribution channels
Sources of starch that are acceptable include:
Corn (aka maize)
What do you do about gluten protein found in wheat, causing the small intestine lining to blunt?
Well you can stop the gluten . So obviously wheat. But also barley, rye, and malt. If there's also problems with oats, you can stop that, because of cross contamination in the fields.
Anything you CAN eat ???
Yeah, there are starches you can eat. So corn. Potatoes. Rice. Tapioca. Soy. Beans. Lots of things .
Cancers, e.g. intestinal lymphoma
Slight increased risk of early death
Intestinal damage begins to heal within weeks of gluten being removed from the diet
Other autoimmune diseases, e.g. DMT1, thyroiditis
Can occur at any age
The disease is increasingly being made in asymptomatic patients, due to increased screening
Ranges from 1 in 300 to as many as 1 in 40
In developed, it is estimated that 83% of cases remain undiagnosed, because of non-classic, minimla, or absent complaints
Slightly more common in women than men
Was described by an ancient Greek description by an ancient Greek doctor, Aretaeus of Cappadocia
Wheat allergy, as Celiac is instead caused by permanent intolerance to wheat proteins