Celiac disease

Celiac disease

Definition

Celiac disease is the genetic autoimmune disease. The body immune system attacks the villi- the tiny, finger-like protrusions lining of the small intestine due to the intake of gluten ( a protein which is found in wheat, barley and rye. If the people have celiac disease, eating gluten will trigger the immune system and it responds by damaging finger-like villi in the small intestine. If the villi become damaged, it will not absorb nutrient into the bloodstream, which can lead to malnourishment. This damage causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

History

• Before World War II, Doctors and researchers thought that celiac disease affects mostly children, and had a death rate about 30%.
• During the war, a doctor noticed the death rate of celiac disease was zero. It is because of limited usage of wheat. Instead of wheat flour, people used potato starch as flour. The reason was found!
• Until 1970’s that celiac disease wasn’t noticed as an autoimmune disorder. Before 1970’s it was noticed as a food allergy.
• In 1990’s, the United States considered this disease as extremely rare and almost not exist. Even though in Europe, there was a rampage of epidemics of celiac disease all over.
• Fasano started to conduct research and it turned out that celiac disease has just as prevalent in the U.S as it was in Europe, but had been generally ignored.
• In the 2000’s, Fasano did a big study and found the prevalence of celiac disease in the US at around 1%, which was 10 times higher than previously thought.
• Without going into detail here (read the article), but at this time a potential connection between celiac and both autism and schizophrenia were found.
• In the 2010’s, celebrities begin to weigh in. (And here is where the fad begins).
• In 2012, Miley Cyrus says she lost weight on the gluten-free diet.
• By 2013, the gluten-free food and beverage industry grew to $10.5 billion.
• In 2017. Dr. Fasano says he hopes the pendulum swings back toward the middle, and people realize that gluten-free is not for weight loss and is not for everyone.

Epidemiology

Celiac disease is a common issue in the US and in Europe. A moderately uniform commonness has been found in numerous countries, range between 1 of every 67 and 1 of every 250 with a rough average of 1% in very much outlined investigations from differing regions, including North and South America, Eastern and Western Europe, Turkey, the Middle East, and North Africa. It is far less common in individuals from Southeast Asia and sub-Saharan Africa.

In populace studies, men and ladies are generally similarly influenced. In clinical practice, be that as it may, ladies tend to make up just about 66% of patients. The primary period time of introduction is in children around age 6 to 7 years; however, celiac disease can emerge when gluten is presented. A moment, bigger peaks happen in the fourth and fifth decades. In spite of the fact that the most widely recognized age at analysis in the US is around 40 years, the celiac disease might be analyzed at any age.

The silent celiac disease is serologic and histologic confirmation of celiac disease, however, with no apparent indications, signs, or insufficiency states. The extent of celiac disease that is genuinely quiet isn’t outstanding, yet it is thought to represent no less than 20% of cases.

The refractory celiac disease is a particular finding inside the classification of nonresponsive celiac ailment, characterized as the constancy of clinical side effects and histologic variations from the norm after no less than a half year on a strict sans gluten eat fewer carbs and without other clear causes or of unmistakable lymphoma. The frequency of headstrong celiac malady in patients with celiac sickness isn’t notable however is felt to be roughly 1%.

Types

There are four types of celiac diseases include:

• Silent
• Latent
• Classical
• Atypical

Silent

People who have the silent celiac disease will not have any symptoms, but they will get positive results for the test. This is usually discovered when your doctor is investigating other disease conditions while taking blood tests.

Latent

The latent celiac disease begins in adulthood, and along with silent celiac disease which has no symptoms can be felt. The doctor will diagnose small intestine or by having a blood test which shows protein in the bloodstream and in intestine shows the damaged villi and the abnormal cells on the wall of the intestine. There is no extra risk of other diseases from the latent celiac disease.

Classical

This type of celiac disease arises in your childhood. Symptoms you may feel, such as bloating and diarrhea.  There is no serious risk in this type of celiac disease. This disease has antibodies which are running in your bloodstream as does all other types. To treat classical celiac disease, gluten-free food should be taken for your diet.

Atypical

The atypical celiac disease begins when you are an adult. Symptoms of this type are totally different from other types. There is no symptom in the small intestine; instead, you will get symptoms such as bleeding, skin rash, and nerve damage. It causes risks of other diseases such as Cancer and Cirrhosis. This can be treated with gluten-free diet. The tissues and cells are removed from your small intestines abnormally.

Causes

• Celiac disease is occurring due to the interaction between the genes, intake of food which contains gluten and other environmental factors. But the main cause is not known.
• Stomach gut bacteria, gastrointestinal infections, and infant feeding practices may develop celiac disease.
• Sometimes, celiac disease is caused or becomes active by due to the surgery, pregnancy, childbirth, viral infections or emotional stress.
• Some gene variations also increase the risk of developing the disease. But having these gene variations doesn’t mean the person will get celiac disease.
• Having family members with celiac disease may also increase the chances of having a celiac disease to 1 in 10.

Risk factors

Celiac disease affects anyone. The people who have other autoimmune disease and some genetic disorders may also cause the risk of celiac disease such as follows.

• Type 1 diabetes
• Rheumatoid arthritis
• Addison’s disease
• Microscopic colitis
• Down syndrome or Turner syndrome
• Autoimmune thyroid disease
• A family member with celiac disease or dermatitis herpetiformis

Symptoms

Symptoms and signs of celiac disease show variations in children and adults. The most common symptoms that appear after eating gluten accidentally in their diet are as follows.

• Diarrhea
• Extreme weight loss
• Fatigue due to malnutrition
• Nausea
• Vomiting
• Bloating and gas
• Constipation
• Abdominal pain
• Mouth ulcers
• Pale foul smelling stool (steatorrhea)
• Heat burn and acid reflux

For children’s under 2 years old the symptoms are as follows.

• Muscle atrophy
• Children’s may not thrive at their expected growth rate
• Distended stomach
• Chronic diarrhea
• Vomiting
• Short Stature
• Delayed puberty
• Attention-deficit/hyperactivity disorder (ADHD)
• Learning disabilities
• Seizures

Celiac disease may have signs and symptoms that are not related to the digestive system include:

• Hyposplenism (less functioning of spleen)
• Blister, skin rash, and itching (dermatitis herpetiformis)
• Numbness and tingling feeling in the hands and limbs
• Cognitive impairment and the problem with body balance.
• Headache

Complications of celiac disease

• Malabsorption: Failure of the intestine to absorb nutrients is known as malabsorption. As a result, it can lead to vitamin and mineral deficiencies such as anemia.
• Early onset of osteoporosis (low bone density) and osteomalacia (soft bone).
• Lactose intolerance: inflammation of the lining of the intestine can stop producing enzymes that needed for the breakdown of lactose.
• Lymphoma and bowel cancer: Untreated and long duration of celiac disease throughout your life lead to adenocarcinoma and cancer of intestine and esophagus.
• Damage to dental enamel: malabsorption of calcium and other minerals lead to permanent damage to tooth enamel.
• Celiac disease in pregnant women can result in low birth weight baby delivery.
• Irritability and depression because of loss of energy due to malnutrition of vitamins.
• Loss of memory and concentration due to lack of important nutrients that produce a chemical called ‘neurotransmitters’ which stimulates the nerve cells.

How do doctors diagnosis and test celiac disease

Medical and family history

The doctor will ask for patient’s medical history if they had other bowel diseases earlier in their life. He also will ask information on family history of celiac disease.

Physical examination

The patient may be examined for the following conditions:

• The doctor will examine patient’s whole body whether rashes, blisters, and itchy feel are present. These are very common conditions of malnutrition.
• Using the stethoscope he may listen to the sounds of the bowel movements
• He may press your abdomen to check for fullness, pain, and swelling
• The doctor can check for dental enamel defects such as white, yellow, or brown spots on the teeth because people with celiac disease have these problems as first notable symptoms.

Blood test

These two tests can help a doctor to diagnose the celiac disease.

Serology test: Certain antibody proteins that are working in gluten tolerance mechanism can be elevated in the blood. A serology test reveals the antibodies that are responsible for an immune reaction to gluten.

Genetic test: Gene testing of human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be very useful for finding the celiac disease. If you are an absence of these antigens, then unlikely you are having celiac disease.

Endoscopy biopsy

If the above blood test results are positive for celiac disease then to confirm endoscopy biopsy is performed. Through the endoscopic device, a doctor views small intestine and take a sample of small tissue (biopsy) to examine the damage to the villi.

How celiac disease is treated

Gluten-free diet

There are no drugs to cure celiac disease. The only way to cure celiac disease is to stick with a gluten-free diet. Your doctor may direct you to visit a dietitian, who can assist with your gluten-free diet. A dietitian may help you to0

• Make everyday meal plans
• Prefer choices of healthy food to eat
• Check for food and product labels about the gluten

Once if the gluten-free diet is taken by the celiac patient, gradually the inflammation in the intestinal lining starts to heal in 3 to 6 months for children and complete heal for adults may take several years.

Foods that are free from gluten are as follow.

• Beans, seeds, and nuts in their natural, unprocessed form
• Eggs
• Meats, fish, and poultry (not breaded, batter-coated or marinated)
• Fruits and vegetables

• dairy products

Hidden gluten foods

• Barley (malt, malt flavoring, and malt vinegar are usually made from barley)
• Rye
• Triticale (a cross between wheat and rye)
• Wheat

Excluding wheat in the diet is very challenging because there are other products which are made from wheat are:

• Durum Flour
• Farina
• Graham flour
• Kamut
• Semolina
• Spelt

Avoid packed foods and drinks unless labeled ‘gluten-free’.

• Beer
• Breads
• Cakes and pies
• Candies
• Cereals
• Communion wafers
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• Processed luncheon meats
• Salad dressings
• Sauces, including soy sauce
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups and soup bases
• Vegetables in sauce

Avoid medications, cosmetics, and other products unless labeled as ‘gluten-free’

• Prescription and over-the-counter medications
• Vitamin and mineral supplements
• Herbal and nutritional supplements
• Lipstick products
• Toothpaste and mouthwash
• Envelope and stamp glue
• Children’s modeling dough, such as Play-Doh

Prevention

• Do screening test and blood tests for elevated antibodies
• Gluten-free diet is the only way to prevent celiac disease
• Check food and medicine labels for wheat flour before ingestion.