lunes, 5 de noviembre de 2018

What is Coeliac Disease?

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By Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Cantab)

Celiac disease affects the gastrointestinal tract - especially the small intestines. It is seen in genetically predisposed children and adults.

The symptoms are usually precipitated by the ingestion of gluten-containing foods. Alternative names for celiac disease are celiac sprue, gluten-sensitive enteropathy, and nontropical sprue.

What is Gluten?

Gluten is a form of plant based protein. It is present in wheat, rye, and barley and gives the dough for bread its baking properties.

Cakes, bread, pasta, breakfast cereals, sauces, beer (made from barley) and ready meals may contain gluten.

Pathology of celiac disease

Celiac disease is an autoimmune condition. The gluten protein makes the immune system sensitive. The overactive immunity thus attacks and damages the surface of the small intestines disrupting the body’s ability to absorb nutrients from food.

Who is affected be celiac disease?

Caucasians are not the only race that is affected. Other races and ethnicities are equally affected.

The risk is higher if a first-degree or a second-degree relative is affected. First degree relatives like parents, offspring and siblings are at greatest risk. This suggests a genetic association. Patients with celiac disease may often suffer from infertility.

Symptoms of celiac disease

In most cases the diagnosis is made around 10 years after the onset of symptoms. Frequently there may be no symptoms at all.

General symptoms of the condition in response to dietary gluten include:-

Unpleasant smelling diarrhea
Abdominal bloating and flatulence
Abdominal pain
Weight loss
Fatigue
Growth retardation

Prevalence of celiac disease

The prevalence of celiac disease in a healthy adult population is seen in a wide range that varies between one in 100 and one in 300 worldwide.

In the majority of these patients the symptoms may be absent or few. The female to male ratio in prevalence is 2:1.

Due to a large population without symptoms of the disease, the actual prevalence of the disease is difficult to determine.

The risks are higher in first-degree relatives (up to 10%) and less so in second-degree relatives.

Those with some other autoimmune diseases, diabetes, arthritis, Down’s syndrome etc. are more at risk of the condition.

Diagnosis of celiac disease

For diagnosis the features that should be positive include:-

Improvement in symptoms when diet is free from gluten
Characteristic histopathology changes in an intestinal biopsy specimen

Serological tests are used to confirm the disease as well as for screening for individuals who are at risk. Serological tests are useful to detect which patients need an intestinal biopsy.

Management of celiac disease

There are no specific medications to be used for treatment of celiac disease except for avoiding dietary gluten completely. This means avoiding wheat, rye, or barley.

This diet needs to be followed for the rest of their lives. Oats are allowed in 95% of patients. Corn and rice-based diets are also allowed.

There is a higher risk of death due to complications of celiac disease and its flare ups. This excess death rate returns to normal after 3–5 years of persistent gluten-free diet.