Last Updated 27 Jul 2020

Celiac Disease

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Celiac Disease Celiac disease is a disease found in the small bowel. This disease does not have a cure. It can only be treated with a strict diet. There are four types of celiac, and all but one can be treated. The disease is a genetically inherited associated with the HL4 locus found on the arm of the chromosome six (schaffner,small-bowel and bacterial overgrowth 2006 pg. 99). This disease can cause a lot of problems with a patient if not treated properly. The proper treatment for most individuals is to go on a gluten free diet. A gluten free diet avoids wheat, rye, barley, and sometimes oats.

Some symptoms are excessive diarrhea, smelly stools, cramps, and weight loss. The most accurate way to diagnose celiac disease is to do an upper endoscopy on the patient. An endoscopy is a procedure with a tube called a scope and a small camera on the end. The scope goes down the patient’s throat to look at their upper gastric region. A biopsy of jejunal mucosa would be done in the small intestine to send to pathology and determine if the patient has celiac disease. When a patient is on a gluten free diet and their body has not responded to it within two years they call this non-responders.

Only five percent of individuals are non-responders. There is also called a refractory sprue this is when someone does not respond to the gluten free diet or has responded and over some time has slipped back and stopped working so the patient has the same symptoms as they did before. There are two types of refractory sprue. Type one is a normal population of intraepithelial lymphocytes. Type two is an premalignant population of intraepithelial lymphocytes based upon clonality analysis of t-cell receptors and immunophenotyping. Type one can never lead to type two, a patient either has one or the other.

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Type one also has a higher survival rate of a five year study. This disease is a slowly growing disease. Now we find in some areas in the populations that it can be higher than one in two hundred and fifty people. Celiac disease is a digestive condition triggered by consumption of the protein gluten. Many individuals will experience an immune reaction to the gluten that is digested. These proteins are mainly found in bread, pasta, and many different foods that contain wheat, barley and rye. Some foods that contain gluten that are over looked are brown rice syrup, energy bars, mitation seafood, processed luncheon meats and many more. When we experience a patient that doesn’t obey the gluten free diet they could do cause damage to the inner surface of the small intestine and not have the ability to absorb certain proteins that the body needs. There are four types of celiac disease. Type one has an increase in T- cell receptor intraepithelial lymphocytes. The symptoms of this type are malnutrition and weight loss with no symptoms of gastrointestinal symptoms. Type two has enlarged crypts along with the intraepithelial lymphocytes.

Type one and two are the only types that can be treated. Type three is present in all symptomatic patients, but many patients with this lesion are asymptomatic. Type four is irreversible and is found in patients who do not respond to gluten withdrawal and in patients with lymphoma (schaffner,small-bowel and bacterial overgrowth 2006 pg. 100). The one way to diagnose a patient with celiac is to do an upper endoscopy and take a biopsy. To get the most accurate diagnosis is to biopsy the jejunal mucosa in the small intestine. They can also do serologic testing. It tests the IgA antigliadin antibody levels.

They mostly use this test to see if the gluten free diet is working. Patients with celiac disease have a higher chance of lymphoproliferative disease and gastrointestinal then the average person. Studies have proven that a person with celiac is more likely to develop other autoimmune disorders like type one diabetes mellitus, and connective tissue disease. Mothers that have not been diagnosed with the disease could have low birth weight newborns and preterm birth compared to the mothers that have already been diagnosed with the disease. The treatment for celiac disease is gluten free diet.

Gluten is a protein in a variety of foods. Oats have no gluten, but often cause problems for patients. They should limit the amount of oats they consume a day about fifty to sixty grams. The number one rule in this diet is to avoid wheat, rye, and barley completely. Always make sure the label is read on items carefully, they find ways to put gluten in different places. The safe things to eat are fresh vegetables, fruits, meats, fish, and eggs. Almost all foods in grocery stores have foods that have been mixed with gluten containing grains, additives, and preservatives.

This makes it hard to find things in grocery stores. Now that this disease has become more noticeable in the communities, patients can find gluten free items in selected grocery stores. With our economy today some patients are unfortunate and cannot afford this gluten free food. For example a loaf of bread with gluten cost no more than three dollars, for a gluten free loaf of bread it cost six. This is doubling the prices on food. So I am sure there are organizations out there that will help someone provide food for themselves or for their children.

Everyone has to watch out for cross contamination if our bread was cooked in the same baking pan as the gluten free bread was the patient with celiac disease would probably have a reaction to this. This is a very hard diet and it takes a lot of getting use too. If the patient looks at this diet in a positive way it will come easier to them. Approximately seventy percent of patients have noticeable clinical improvement within two weeks (Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www. uptodate. com).

Once a patient reaches remission stage in the diet, some patients are able to consume little amounts of gluten and tolerate it and some have to stay on the diet from then on. A patient should be evaluated four to six weeks after starting the gluten free diet to have a complete blood count, folate, B12, iron studies, liver chemistries, and serologic testing to see how they are doing and making sure nothing else is wrong. A gluten free diet is the only treatment for celiac disease. So when a patient is a non-responder to the gluten free diet they could be in some danger.

This is a rare thing that happens only in five percent are non-responders. Patients who do not respond fall in five categories. * Patients with poor compliance or inadvertent gluten ingestion * Patients with clinical or histologic features that overlap with celiac disease but are caused by other disorders * Patients with concurrent disorders * Patients with refractory sprue * Patients with ulcerative jejunitis or intestinal lymphoma The most common reason for non-responders is poor compliance or inadvertent gluten ingestion. These patients need to go to a specificity trained dietitian.

Patients with concurrent disorders should be considered in patient who despite apparent compliance, continue to have symptoms or do not have histologic improvements. Refractory sprue has two types. Type one is when there is a normal population of intraepithelial lymphocytes. Type two is when there is an aberrant or premalignant population of intraepithelial lymphocytes base upon conality analysis of t-cell receptors. Patients with type one have less severe presentation and a more better prognosis than patients with type two disease. Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www. uptodate. com ) On a five year study survival was higher in the type one group. In type two most deaths were due to the development of t-cell lymphoma. No patients with type one developed type two, so it doesn’t progress into one another. Refractory sprue can be severe and associate with progressive malabsorption and death (Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www. uptodate. com). The cause of this is unknown.

Ulcerative jejunitis and lymphoma should be considered in patients with refractory sprue unresponsive to glucocorticoids (Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www. uptodate. com). Patient with ulcerative jejunitis have multiple chronic benign appearing ulcers, most frequently in the jejunum. Patients could have recurrent symptoms of malabsorption, lassitude, anorexia, abdominal pain, diarrhea, fever despite being on a gluten free diet this disease is found in middle aged patients with underlying celiac disease. Celiac disease is a digestive condition triggered by consumption of the protein gluten.

There is not a cure for this disease but there is a treatment. A gluten free diet is the treatment for this disease. It is a hard and intense diet to stick to. There are many complications that happen to the body when on a gluten free diet. The body doesn’t get enough vitamins and minerals. Gluten is any wheat, rye or barley. Ninety percent of the food that is eaten today has gluten in it at some degree. Very rare does a person not respond to a gluten free diet, they call this non-responders. The disease is a genetically inherited disease associated with the HL4 locus found on the arm of the chromosome six. schaffner,small-bowel and bacterial overgrowth 2006 pg. 99). We should have all of our family checked for this disease if someone in the family has had it. This is a disease this country is starting to see more and more. References Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www. uptodate. com Greenberger; Blumberg; Burakoff; current diagnosis & treatment;2009; McGraw Hill companies Hauser, MD; pardi, MD; Poterucha MD; mayo clinic gastroenterology and hepatology board review, second edition;2006

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