Celiac Disease Or Gluten-sensitive Enteropathy

By Author: Sulamita Berrezi
Total Articles: 115
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Celiac disease or gluten-sensitive enteropathy is the major small intestinal cause of malabsorption in the Western world. In the United Kingdom, it occurs in 1 in 120-300 of the population; it is more frequent in females. It may be associated with dermatitis herpetiformis, type 1 diabetes, rheumatoid arthritis, and autoimmune thyroiditis. It usually involves the upper part of the small bowel and is due to a T cellmediated immune response to a constituent of wheat flour, gluten. This toxic component of gluten (identified as gliadin) causes damage to surface enterocytes with villous atrophy and crypt hyperplasia. There is marked reduction in absorptive capacity of the small bowel with resultant malabsorption of nutrients. Prompt clinical improvement occurs on withdrawal of the gliadin fraction of wheat gluten. Patients present with symptoms of diarrhea, steatorrhea, weight loss, and general malaise. Sensitivity to gluten occurs in other diseases such as dermatitis herpetiformis and results in a rash and similar intestinal changes to celiac disease. The diagnosis is made by testing the blood for the presence of anti-endomysial ...
... antibodies or antitransglutaminase antibodies and confirmed by duodenal biopsy, which shows villous atrophy and crypt hypertrophy, flattened surface epithelial cells, and a chronic inflammatory infiltrate into the lamina propria that resolve following a gluten-free diet. All cereal grains contain gluten (wheat, barley, and rye), and these should be removed from the diet. Maize flour, rice, potatoes, and gluten-free flour are available and acceptable. Response to oats is more difficult to predict, perhaps because they may be contaminated by wheat products. It often takes several weeks to respond to a glutenfree diet and response is seen by rapid gain in weight. Lifelong adherence to the diet is necessary for celiac patients. Some patients present dehydrated, and fluid and electrolyte replacement may be required. Patients are often anemic secondary to iron, folate, or, much less often, vitamin B12 deficiency and should receive supplementation. Vitamin D and K deficiency is common and absorption of vitamins B6 and C may also be impaired. Steatorrhea may also cause calcium, magnesium, or zinc deficiency. All nutritional deficiencies should be corrected until the intestinal lesion has resolved on the gluten-free diet. In untreated celiac disease, as in other diseases that affect the absorptive capacity of small intestinal enterocytes, disaccharidase deficiency may result, with symptoms of diarrhea and abdominal distension in response to milk products that contain lactose. Once the mucosa returns to normal with the gluten-free diet, disaccharidase activity returns to normal and lactose (milk sugar) becomes tolerated again.