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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Celiac disease

Celiac DiseaseCeliac disease is not food intolerance or allergy but a digestive disease that damages the small intestine and interferes with the absorption of nutrients from food. People with celiac disease cannot tolerate gluten, a complex protein found in the grain of wheat. Similar proteins are found in other grains, such as barley, rye, and to a smaller extent oats.

When people with celiac disease eat or use products containing gluten, their immune systems respond by causing inflammation in the lining of the small intestine. Over time, the lining of the small intestine breaks down and the tiny villi (finger like projections) that absorb food into the bloodstream become damaged or destroyed. In other words, celiac disease is both a digestive disease (involving the malabsorption of food) and an abnormal immune system response too gluten.

Celiac disease, also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy, has a genetic component. The celiac condition tends to run in families.

Cause:

The immune system is designed to recognize and protect the body from foreign material, such as viruses, bacteria and other germs. This defense system also monitors the uptake of digested food in the small intestine. In some people, gluten is recognized as a foreign substance, resulting in an auto immune response.  “Gluten” is the collective term for the amino acid sequences found in wheat, barley, rye and, to a lesser extent, oats, which trigger the immune response. In the case of celiac disease, the immune system generates an abnormal response to gluten and attacks its own intestinal tissue, resulting in inflammation. Over time, the villi lining the small intestine waste away, leading to the malabsorption of nutrients and thus malnutrition.

Celiac versus non-celiac gluten sensitivity

Celiac disease and gluten sensitivity both come with the recommendation of avoiding gluten-containing foods. However, these diagnoses are different in the way they affect the body and the reasons for following a gluten-free diet.

The term “celiac” refers to a metabolic predisposition or the body’s inability to digest gluten and certain other grain proteins. This predisposition only develops into full blown disease if the body’s inability to digest gluten is ignored at the expense of the immune system (i.e. a person does not follow a gluten free diet and lifestyle). Celiac disease is therefore caused by a combination of genetic and environmental factors.

Non-celiac gluten sensitivity is often referred to as gluten intolerance. The term sensitivity is used if symptoms are mild, whereas more severe cases are labeled gluten intolerance due to their intensity and persistence. If a person is gluten sensitive / intolerant their body views gluten as an invader causing a direct response in the form of inflammation inside and outside of the digestive tract. It differs from the auto-immune response of celiac disease, in that the body’s own tissue is not attacked. Once gluten is removed from the body, the inflammation goes away. Symptoms include bloating, abdominal discomfort, and diarrhoea. Headaches, lethargy, muscle weakness / disturbances and joint pain may also present.

Symptoms:

Celiac disease can develop at any age. The disease may be triggered or become active for the first time, following pregnancy, childbirth, surgery, viral infection, or severe emotional stress. Celiac disease affects people differently depending on their age and the amount of damage to the intestine. When and how the disease develops may also be influenced by factors such as the length of time a person is breastfed, when they start eating foods containing gluten, and the amount of gluten they consume.

Babies – symptoms first develop when the baby is weaned and introduced to solid foods containing gluten. Due to poor food absorption, baby may fail to grow or thrive. Their stools may appear pale, bulky or fatty. Other symptoms include smelly diarrhoea, frequent vomiting and a swelling in the abdominal area.

Older children – symptoms in older children may be similar to babies. Poor nutrient absorption may result in vitamin and mineral deficiencies. Problems such as anaemia may develop. Nutrients are critical to healthy growth and development. Children with the celiac condition may appear short in stature, experience delayed growth, delayed puberty and dental enamel defects of permanent teeth. Irritability is another common symptom in children.

Adults – Frequently occurring symptoms include abdominal pain which tends to come and go, bloating, excess wind, diarrhoea, tiredness or weakness, and mouth ulcers. Sufferers may lose weight due to poor food absorption. However, most adults with coeliac disease do not lose weight and are not underweight. Other symptoms may include unexplained iron-deficiency anemia, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, a tingling numb sensation in the hands and feet, seizures, missed menstrual periods, infertility or recurrent miscarriage, or an itchy skin rash called dermatitis herpetiformis.
If symptoms are mild or atypical, it may take time for a diagnosis to be made. In adults, areas affected in the gut may be patchy and symptoms may seem unobvious. In children, the first sign of inadequate nutrient absorption is generally poor growth.

Diagnosis:
Because the symptoms of the celiac condition are variable and similar to those of other conditions, diagnosis should be made by a medical doctor. A series of tests and evaluations are performed including an examination of one’s family history, blood tests, and the final confirmation of an intestinal biopsy. To ensure an accurate diagnosis, diagnostic tests should be performed before restricting gluten.

There are four major steps in the diagnosis of celiac disease:
1. Examination
If your doctor suspects the celiac condition, he will ask various questions relating to your personal and familial health history. For example, what are your physical and emotional symptoms, how long have they been present, when and for how long do the symptoms occur, have you noticed a pattern, do family members have any autoimmune diseases? In the case of children, it is important to establish if their physical and emotional health is within the normal range.
Depending on the presentation of symptoms, your physician will perform tests to check for relevant problems and conditions. For example, protruding or distended abdomen (intestine dysmotility), low blood pressure, or emaciation. Symptoms such as diminished deep tendon reflexes or muscle spasms may indicate magnesium and/or calcium deficiency, while bone tenderness and bone pain may be due to osteomalacia.
2. Serology / blood tests
People with celiac disease have higher than normal levels of certain autoantibodies (proteins that react against the body's own cells or tissues) in their blood. There are a number of tests that can aid in the diagnosis of celiac disease. These tests are sometimes collectively referred to as the Celiac Blood Panel or Cascade. To diagnose celiac disease, doctors will test your blood for high levels of:
EMA - Immunoglobulin A anti-endomysium antibodies
AGA - IgA anti-gliadin antibodies (Some people do not produce IgA antibodies)
DGP - Deamidated gliadin peptide antibody
tTGA - IgA anti-tissue transglutaminase
These blood tests are only accurate while on a gluten-containing diet
3. Biopsy
If clinical signs and positive blood tests indicate probable malabsorption, a biopsy of the small intestine may be scheduled. In this test, a flexible biopsy tube is used to gather multiple snippets of small intestinal tissue, with the aim of assessing gut damage. For those with suspected dermatitis herpetiformis, skin biopsies will be taken of the skin near the lesion.
In an untreated or undiagnosed celiac patient, the normal finger-like projections (villi), which increase the absorptive surface area of the small intestine, are partially or totally flattened. Enzymes located on the brush border are also drastically reduced.  The enzymes produced at the tips of the villi are responsible for metabolizing carbohydrates.  Lactase, the enzyme necessary for the digestion and processing of milk sugar (lactose), is an example of one of these brush border enzymes. A decrease in lactase explains why some untreated celiac patients are unable to tolerate milk products and have developed transient or permanent lactose intolerance.  At the base of the villi elevated numbers of T-cell lymphocytes (white blood cells) are also present.
4. Remission of symptoms on a gluten-free diet

Treatment:

There is currently no cure for celiac disease. Treatment involves the elimination of gluten and adherence to a gluten free lifestyle for optimal health. There is no "typical celiac." Symptoms of celiac disease vary, as do the related medical conditions. Diet and treatment needs are unique to each individual. What may work for one may be totally inappropriate and / or damaging for another. Expand your knowledge about your disease or condition. Keep a daily food diary to identify and eliminate suspected triggers. Work with a nutritionist and learn how to shop, cook and eat gluten-free. Read all food labels and be aware of hidden sources of gluten. To make the dietary transition easier, enlist the support of your friends and family. A lifestyle change takes patience and understanding. Successful treatment requires patient education and medical follow-up.

Complications:

The longer a person goes without the disease being diagnosed or treated, the greater their chance of developing long term complications. People with coeliac disease have an increased risk of:

  • Developing osteoporosis (weakening of the bones), due to the poor absorption of nutrients associated with the disease.
  • Developing a type of cancer (lymphoma) in the gut, later in life. This is rare.
  • Developing other auto-immune diseases, such as Type 1 diabetes, hypothyroidism (underactive thyroid), Sjögren's syndrome and primary biliary cirrhosis.
  • Having a low birth weight or premature baby.

Adherence to a gluten free diet for life can prevent almost all complications associated with the disease.

Prognosis:

Prompt diagnosis is imperative for the best health outcome. Damage from gluten is cumulative. The earlier gluten is removed from the diet, the less likely health complications will develop. In most cases, the body quickly returns to health after initiating a strict gluten-free diet.
Although cutting out gluten may seem daunting at first, the long term health benefits will outweigh the challenges and potential inconvenience caused. Working closely with a knowledgeable physician, educating oneself, practicing wise self-management skills, and joining a support group will help a person with celiac disease live life to the fullest.     

 
http://www.celiac.com/
http://www.patient.co.uk/health/coeliac-disease-leaflet
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
http://www.csaceliacs.info