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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 proteins Gliadins, 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