celiac’s disease
Post on 06-Jan-2016
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Celiac’s DiseaseChloe Bierbower
Kelly LonergonBrittany Pinkos
Sarah Steinmetz
What is Celiac’s disease? An autoimmune enteropathy triggered by
the ingestion of gluten-containing grains in susceptible individuals resulting in intestinal damage
Disease of both malabsorption and abnormal immune reaction to the protein gluten
Main groups of proteinsGliadins, glutenins and other alcohol-soluble
proteins found in grains Also known as celiac sprue, nontropical
sprue and gluten- sensitivity enteropathy
What is Gluten Composite formed from several different
proteins Found most commonly in wheat and
other related grains Used in many processed foods as a
thickener, binder, flavor enhancer and protein supplement
The Autoimmune response CD is the result of inappropriate T cell-
mediationGlutenin and gliadin (GLU) derived peptides
in native or de-amidated form act as antigens
Activates lamina propria to infiltrate CD4+ T lymphocytes isolated from intestinal mucosa from small intestine
Leads to the release of proinflammatory cytokines (in particular y-interferon) which cause profound tissue remodeling
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Specific CD4+ T-cell responses to GLU peptides are due to genes HLA-DQ2 and HLA-DQ8
Possible to have 2 HLA-DQ2 genes, 2 HLA-DQ8 genes or one of each
2 HLA-DQ2 genes results in the highest susceptibility for CD
The occurrence of either of these genes does not mean a patient will develop CD
The Autoimmune Response
CLinical research study Study found that both adult and young
patients with CD, regardless of which genes expressed, can respond to a diverse repertoire of GLU peptides
Still don’t know if a specific GLU protein triggers a specific immunologic response
responsehttp://glutenintolerance.net/Celiac-Gluten-Gliadin-Peptides-Multiple-Vader.pdf
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Consequences of the autoimmune response Immune reaction attacks and destroys
small intestinal villi Small intestinal villi aids in the
absorption of nutrients Without healthy villi the intestine cannot
extract and absorb nutrients from food no matter the quantity of food consumed
Causes? Unclear as of now It is genetic Sometimes triggered or becomes active
after surgery, pregnancy, childbirth, viral infection or severe emotion stress
Some gene mutation increase risk More common in people with type 1
diabetes, autoimmune thyroid disease, down syndrome, and microscopic colitis
What are the symptoms of CD? Symptoms subdivided in typical or
atypical forms Vary with the age of the patient, duration
and extent of disease and the presence of extraintestinal pathology
Can be completely asymptomatic
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SYmptoms of CD Typical form (Typically in infants 6-18
months of age)chronic diarrhea failure to thriveabdominal distentionanorexiamuscle waisting
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Symptoms of cd Atypical form (more common in older
children and adults)dermatitis herpetiformis iron-deficiency anemiashort staturedentil enamel hypoplasiaarthritis and arthralgiachronic hepatitis and hypertransaminaemiaosteoporosisneurologic problemsother GI problems
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Adults are less likely to witness normal symptoms but may experience instead….
Fatigue bone or joint pain Arthritis Bone loss/
osteoporosis depression or
anxiety Tingling or
numbness in hands and feet
seizures
Missed menstrual periods
Infertility or recurrent miscarriages
Canker sores inside the mouth
Itchy skin rash called dermatitis herpetiformis
Why are symptoms varied? Currently being studied Could depend on length of time the
person was breastfed Age the person starting consuming
gluten Amount of gluten containing foods a
person eats Condition of the persons small intestine
A number of medical conditions are significantly associated with cd Type 1 diabetes Autoimmune atrophic gastritis Autoimmune emocytopenic diseases Autoimmune thyroid disease Autoimmune liver disease Rheumatoid arthritis Addison’s disease Sjogren’s syndrome 2-5% of patients with CD develop refractory
CD, a serious complication associated with 50% risk of lymphoma development
Epidemiology of cd Originally thought to be a rare childhood
disease Can be diagnosed at any age because
CD may develop later in life Over 2 million Americans have CD Affects approximately 1 in every 133
Americans, similar European statistic Global prevalence of CD is increasing
How is Celiac disease diagnosed? Difficult to diagnose Often mistaken for other diseases
IBS, Diverticulitis, intestinal infections Histological and serological testing are
essential look for abnormalities in small intestine and
presence of certain IgA autoantibodies Positive diagnosis made when:
1. typical small-intestinal histopathological abnormalities defined as hyperplastic villous atrophy
2. clinical remission on a strict gluten-free diet with relief of symptoms within weeks
How is it treated? Only known treatment is a Gluten- Free
DietComplications
Common for food presumed to be “gluten free” is contaminated
Expensive Some medications and vitamins contain gluten
Supportive nutritional care with emphasis on iron and calcium
The Gluten free diet Includes not eating foods that contain
wheat, barley or rye and certain soy products
Products made from these include cereals, pasta, and many processed foods
Important to talk to chefs, waiters and pharmacists
Foods To avoid Foods containing wheat, barely, or rye Bulgar (several different wheat species) Durum (species of wheat) Farina (cereal food, cream of wheat) Graham flour (whole wheat flour) Semolina (purified wheat from durum
wheat) Spelt (ancient wheat species) Triticale (wheat-rye hybrid) Foods that contain these unless specified
“gluten free”
overall most common physical Complications of cd Malnutrition Iron deficiency anemia Loss of calcium and bone density Lactose intolerance
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psycho/social effects of CD -Methods: 130 members ages 19-78 of Celiac UK write narratives on living with celiac
disease in response to “Please give a written account of your experience of living with coeliac disease”
-Results: 5 categories
1) Living with widespread ignorance
-can be undiagnosed for many years
-public ignorance
-self-education often a coping strategy
2)Social invisibility
-limited processed foods are gluten-free
-helped by clear labeling
-since eating is often a social activity, and very often CD is overlooked
3)Creating a coeliac community
-support from family and friends
-feel different from the community around them
4) A changed identity
-people’s reactions to when they don’t eat certain foods
-worries of dietary self-management
-social anxiety in terms of violating appropriate rules of politeness
5) Grief – and accepting the trade-off
-grief- response to diet restriction
-easier to make change to gluten-free diet if previously cooked
-trade-off- health can be restored
http://onlinelibrary.wiley.com/doi/10.1111/jhn.12062/full
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease-topic-overviewhttp://www.sciencedirect.com/science/
article/pii/S0165247805000702
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