Sunday, August 28, 2011

Celiac disease

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Celiac disease
Celiac disease is a condition in which the lining of the small intestine (Villi) is destroyed due to reaction to eating gluten resulting in loss of ability to absorb certain nutrients and resultant malnutrition.

Gluten is found in wheat, barley, rye and oats. Some individual develop immune reaction towards gluten and when they eat food containing gluten, their villi present in the small intestine are damaged due to this immune reaction.


Incidence, cause and risk factors

• Exact cause is unknown.
• People with celiac disease develop an auto immune reaction towards gluten which destroys the lining of the small intestine resulting in loss of its ability to absorb nutrients.
• The person becomes malnourished as a result of this and signs and symptoms of malnutrition occurs.
Gluten free diet in celiac disease

This disease can occur at any stages of life. An individual with a family history of celiac disease are more vulnerable to developing this disease. Caucasians and persons of European ancestry are at greater risk of developing celiac disease. Women are more prone to get this disease than men.

Associated disorders

Celiac disease can cause diseases like – Rheumatoid arthritis, Addison’s disease, Down syndrome, Sjogren syndrome, Systemic lupus erythematous, Some types of intestinal cancer, lymphoma, diabetes mellitus, lactose intolerance and thyroid disease.

Signs of celiac disease

• Abdominal pain, gas and indigestion
• Constipation or diarrhoea
• Appetite changes (Increased or decreased)
• Nausea and vomiting
• Foul smelling, fatty stools
• Weight loss
• Signs of malnutrition

Diagnosis

Serum Albumin test show below normal levels of albumin.

Alkaline phosphatise may be increased significantly because of loss of bone.

Abnormalities of blood clotting mechanism.

Blood test reveals signs of anaemia

Low cholesterol levels

Blood tests for specific antibodies-
• Anti-tissue transglutaminase antibodies
• Anti-endomysium antibodies

If the above tests are positive for celiac disease, an upper endoscopy is performed to take the biopsy of the small intestine which may show abnormalities of villi.

To find out who are at risk of developing celiac disease genetic testing can be done for the presence of genetic factors associated with this condition.

Treatment

There are no treatment modalities that can cure the disease completely. The person is instructed to avoid diet containing gluten. He has to avoid eating foods containing wheat, barley, rye and oats. Make sure that you read the label of any food items to find out the presence of gluten. Once you started a gluten free diet, villi that is present on your intestine starts to grow slowly and the signs gradually disappear. Time taken for this changes varies with the age and general health status of the person. For children, it takes 3 to 4 months for complete cure and growth of villi but in adults it is few years for complete cure and growth.

During the treatment, physician may order certain minerals and vitamins to compensate your daily requirements. These vitamins and minerals are administered intravenously because your intestine is not able to absorb them if taken in oral route.

Sometimes corticosteroids are prescribed (e.g.: Prednisone) to suppress the immune reaction.

Prognosis

Symptoms usually subsides gradually as the lining of the small intestine is healed with the gluten-free diet. Additional treatments may be necessary to cure associated disorders.
Complications

If not treated celiac disease may lead to complications or even a life-threatening condition.

• Immune system disorders
• Diseases of bone
• Cancer
• Retarded growth and development for children
• Infertility
• Systemic diseases

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