CELIAC DISEASE

Celiac disease primarily affects the small intestine but is a long-term autoimmune disorder where individuals develop intolerance to gluten, which is present in foods such as wheat, rye, and barley. The occurrence of this problem may depend on the variety of oats. It also occurs in genetically predisposed people.

Celiac disease is caused by a reaction of gluten, a group of various proteins found in wheat and in other grains, i.e., barley and rye.

Upon exposure to gluten, an abnormal immune response may lead to the production of different autoantibodies which can affect various different organs.

An inflammatory reaction occurs in small bowel, may produce shortening of the villi lining the small intestine (vilous atrophy). This affects the absorption of nutrients, leading to anaemia.

SIGN AND SYMPTOMS

Classic symptoms include chronic diarrhea, abdominal distention, malabsorption, and effects on normal growth in children. In children, celiac disease often begins between six months and two years of age.

Non-classic symptoms are more common, especially in people who are older than two years. There are mild or absent gastrointestinal symptoms, numerous of symptoms involving any part of the body, or no obvious symptoms.

Celiac disease was first identified in children, but it can occur at any age. It is related to other autoimmune diseases, like wise Type 1 diabetes mellitus and Hashimoto's thyroiditis, among others.

Celiac disease leads to an increased risk of adenocarcinoma of the lung and lymphoma of the small bowel (enteropathy-associated T-cell lymphoma (EATL) or other non-Hodgkin's lymphomas). This risk is also higher in relatives, siblings, parents and children.

Malabsorption of carbohydrates and fats may cause loss of weight, failure to grow in children, fatigue, or lack of energy.

Anaemia may develop in a number of cases. Iron malabsorption may cause iron deficiency. Folic acid and vitamin B12 malabsorption rise to megaloblastic levels.

Calcium and vitamin D malabsorption and compensatory secondary hyperparathyroidism may cause osteopenia or osteoporosis.

Combined with the low selenium content in many gluten-free foods, this confers a risk of selenium deficiency (selenium malabsorption).

Copper and zinc deficiencies have also been related to celiac disease.

Because of vitamin K deficiency, a small proportion have abnormal coagulation and are at a slight risk of abnormal bleeding.

Dermatitis herpetiformis has been linked to a transglutaminase enzyme in the skin, features small-bowel changes identical to those in Celiac disease, and may respond to gluten withdrawal despite no gastrointestinal symptoms being present.

Pregnancy complications can occur if Celiac disease is pre-existing or later acquired, with significant outcomes including miscarriage, intrauterine growth restriction, low birth weight and preterm birth.

Hyposplenism occurs in about a third of celiac disease cases and may be a cause of infection, given the role of the spleen in defending harmful bacteria.

Liver function tests seem abnormal.

DIAGNOSIS

Several tests can be used. The order of the tests may be determined after observing the level of symptoms, but all tests lose their usefulness if the patient is already eating a gluten-free diet.

Intestinal damage begins to settle within weeks on removal of gluten from the diet, and antibody levels decline over months.

For those patients who have already started a gluten-free diet, it may be necessary to perform a rechallenge with some gluten-containing food at one meal a day over 6 weeks before repeating the investigations.

TREATMENT

The only known effective treatment is a strict lifelong gluten-free diet, which leads to recovery of the intestinal mucosa, improves symptoms, and reduces the risk of developing complications in most patients.

If the treatment of the case is not made, it may result in cancers such as intestinal lymphoma, and a slightly increased risk of early death.

Rates vary between various regions of the world, from 1 in 300 few to 1 in 40 many, with an average of between 1 in 100 and 1 in 170 people.

According to an estimate, about 80% of cases remain undiagnosed because of minimal or absent gastrointestinal complaints and lack of knowledge about the symptoms and diagnostic criteria. Celiac disease is more common in women than in men.