Celiac Disease

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1- Introduction

2- Pathophysiology

3- Symptoms

4- Treatment

Introduction

Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. Gluten is a protein found in wheat, barley, and rye. In people with celiac disease, eating gluten triggers an immune response that attacks the small intestine, damaging the villi—small fingerlike projections that line the small intestine and promote nutrient absorption. Over time, this damage can prevent the absorption of nutrients from food, leading to various health problems such as anemia, osteoporosis, and neurological issues.

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Pathophysiology

The pathophysiology of celiac disease involves a complex interaction between genetic predisposition, environmental factors, and the immune system. Individuals with celiac disease possess specific genetic markers, primarily HLA-DQ2 and HLA-DQ8, which predispose them to the condition. Upon ingestion of gluten-containing foods, the protein is partially digested in the gastrointestinal tract, producing gliadin peptides. These peptides are then deamidated by the enzyme tissue transglutaminase (tTG), which modifies them to enhance their binding affinity to HLA-DQ2 or HLA-DQ8 molecules on antigen-presenting cells. This complex triggers an inappropriate immune response, activating T cells that release pro-inflammatory cytokines and induce a chronic inflammatory state in the small intestine. This immune response leads to villous atrophy, crypt hyperplasia, and increased intestinal permeability, impairing nutrient absorption. Over time, the sustained inflammation and damage to the intestinal lining can result in various systemic symptoms and complications.

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Symptoms

Gastrointestinal Symptoms:

  1. Diarrhea: Chronic diarrhea is a common symptom.
  2. Constipation: Some individuals may experience constipation instead of diarrhea.
  3. Bloating: Persistent bloating and gas can occur.
  4. Abdominal pain: Frequent and often severe stomach pain.
  5. Nausea and vomiting: Some people may feel nauseous or vomit after consuming gluten.
  6. Weight loss: Unexplained weight loss due to malabsorption of nutrients.

Non-Gastrointestinal Symptoms:

  1. Fatigue: Chronic fatigue and general weakness.
  2. Anemia: Iron-deficiency anemia that doesn’t respond to iron supplements.
  3. Osteoporosis: Bone loss due to poor absorption of calcium and vitamin D.
  4. Dermatitis herpetiformis: An itchy, blistering skin rash.
  5. Headaches and migraines: Frequent and severe headaches.
  6. Joint pain: Arthritis-like pain in joints.
  7. Neurological symptoms: Including numbness and tingling in the hands and feet (peripheral neuropathy).
  8. Mood disorders: Depression and anxiety.
  9. Dental enamel defects: Damage to tooth enamel.
  10. Delayed growth: In children, celiac disease can cause delayed puberty and slow growth.
  11. Infertility: Reproductive issues, including infertility and miscarriage.

Treatment

Gluten-Free Diet:

  1. Avoidance of Gluten: Eliminate all sources of gluten from the diet, including foods like bread, pasta, cereals, and baked goods, unless they are specifically labeled gluten-free.
  2. Reading Labels: Careful reading of food labels is essential to identify hidden sources of gluten in processed foods, sauces, and condiments.
  3. Cross-Contamination Prevention: Ensuring that food is not cross-contaminated with gluten during preparation and cooking, particularly in shared kitchens.

Nutritional Support:

  1. Nutrient Supplementation: Some individuals may require supplements to address deficiencies in iron, calcium, vitamin D, vitamin B12, and other nutrients.
  2. Dietary Guidance: Consulting with a dietitian who specializes in celiac disease can help ensure a balanced and nutritious gluten-free diet.

Monitoring and Follow-Up:

  1. Regular Check-Ups: Periodic follow-ups with a healthcare provider to monitor symptoms, nutritional status, and adherence to the gluten-free diet.
  2. Antibody Testing: Blood tests to measure levels of specific antibodies (such as tissue transglutaminase antibodies) can help assess dietary compliance and intestinal healing.

Managing Complications:

  1. Addressing Associated Conditions: Managing other autoimmune disorders or complications like osteoporosis, anemia, and dermatitis herpetiformis.
  2. Bone Health: Ensuring adequate intake of calcium and vitamin D to support bone health and prevent osteoporosis.

Psychological Support:

  1. Support Groups: Joining support groups or counseling to help cope with the social and emotional challenges of living with celiac disease.
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