A Family Doctor's Tale - CELIAC DISEASE

DOC I HAVE CELIAC DISEASE

Celiac disease is an illness of the small intestine whose lining is damaged by sensitivity to gluten leading to malabsorption and weight loss.

It can be dangerous disease unless detected early. So far I have only seen one case in 37 years.

Luckily for the patient the endoscopy down the duodenum was able to detect his condition.

By stopping all gluten in his diet he was able to live a normal life.


Celiac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which causes the lining of the small intestine to develop abnormalities of absorption of food as a result of contact with gluten.

The small bowel mucosa will show
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells

The small intestine is unable to absorb food so that the patient dies of malnourishment even if he takes a lot of food.


Celiac Disease is more common in people with certain anti-tissue transglutaminase antibodies or anti-endomysium antibodies.


There is a possibility of enzyme deficiency and abnormal immunological response.

Celiac Disease can be found in all ages but are more common in the 10-30 years age group.

The exact cause of Celiac Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Celiac Disease.

A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the  small intestinal tract resulting in inflammation.

Symptoms varies from mild to severe:

1.severe abdominal pain, bloating

2.diarrhea and steatorrhea

3.Weight loss despite good appetite and intake

4.edema

5.glossitis

6.apthous ulcers

7.finger clubbing

8.hypotension

9.Polyneuritis

10.psychiatric symptoms such as depression or anxiety


In children there may be:
1.failure of weight gain

2.irritability

3.general malaise

Diagnosis of Celiac Disease is confirmed by:

1.A history of abdominal pain , diarrhea and weight loss

2.small bowels radiology

3.D-xylose absorption study

4.fecal fat assessment

5.low blood hemoglobin, albumin and cholesterol

5.Low blood clotting factors

6.duodenum biopsy can show the flattening  of the villi


Complications of Celiac Disease are:

1.weight loss

2.Nutrition:

malabsorption and vitamin deficiency

Treatment of Celiac Disease is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place

2.avoid beer ale whisky vodka which contains a lot of gluten

3.Special diet for gluten sensitive patients

4.Question diet and review diagnosis if  response to gluten free diet is poor


Medication

1.Antispasmotic medication for abdominal pain

2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

3.Correction of anemia and nutritional deficiencies is important to enhance the immune system

Prognosis of Celiac Disease:

The prognosis depends on the condition of the disease

Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 3 years for symptoms control.

There may be recurrence if therapy is stopped.

Preventive measures in Celiac Disease are:

A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

A gluten free diet will prevent recurrence