Celiac disease (from Greek "koiliakos" meaning "abdominal" is an autoimmune disorder of the small intestine that occurs in genetically predisposed Pt's.
Patient information
What is celiac disease?
It's where the body's cells attacks itself. Specifically, of the small intestines.
Pathophysiology
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
Patient information
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.
Sx
Pain and discomfort, in the GI tract
Chronic constipation
Diarrhea
Vitamin deficiency
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
Anemia
Fatigue
Patient information
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.
Dx
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
Tx
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:
Wheat
Barley
Rye
Malt
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)
Potatoes
Rice
Tapioca
Soy
Beans
Patient information
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 .
Complications
Cancers, e.g. intestinal lymphoma
Prognosis
Slight increased risk of early death
Intestinal damage begins to heal within weeks of gluten being removed from the diet
Comorbidities
Other autoimmune diseases, e.g. DMT1, thyroiditis
Epidemiology
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
See also
Wheat allergy, as Celiac is instead caused by permanent intolerance to wheat proteins
Medicinenet.com Word of the Day Medicinenet.com Daily News
Medpage Today Latest Medical News
Health.com Happy & Healthy
Medical News Today headlines
Internal Medicine Clinical News
Modern Medicine News Modern Medicine Feature articles
Cleveland Clinic Journal of Medicine
BMJ Latest news BMJ Latest research BMJ Education
JAMA Current issue
The Lancet Current issue
NEJM Current issue
ScienceMag Current issue
NIH PubMed Health Featured reviews
ABC Health news ABC Health & Wellbeing ABC Health Minutes ABC RN's The Health Report ABC All in The Mind
BBC News - Health (International)
NSW Health Minister for Health Minister for Mental Health NSW Health Publications AI of Health & Welfare Publications Department of Health Publications
WHO Health news WHO Emergencies, disasters news WHO Disease Outbreaks WHO Health feature stories