celiac disease
DESCRIPTION
Celiac Disease. The “Great Mimic” Disease. Celiac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with the absorption of nutrients from food. It occurs in reaction to gluten, a protein found in rye, barley, and wheat. - PowerPoint PPT PresentationTRANSCRIPT
The “Great Mimic” Disease
Celiac Disease
What Is Celiac Disease?*Celiac disease is an autoimmune digestive
disease that damages the villi of the small intestine and interferes with the absorption of nutrients from food.*It occurs in reaction to gluten, a protein found in
rye, barley, and wheat. *Eating gluten triggers an immune response in
the small intestine producing inflammation.*1% of the population (3 million people) have it.*It is estimated that 83% of Americans who have
this disease are undiagnosed or misdiagnosed*6-10 years is the average time a person waits to
be correctly diagnosed.
Gastrointestinal Manifestations
*Chronic diarrhea with or without weight loss* Abdominal pain* Vomiting / Nausea* Constipation* Abdominal distension or bloating
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Non Gastrointestinal Manifestations*Dermatitis Herpetiformis
* Iron-deficiency anemia resistant to oral Fe*Dental enamel hypoplasia of permanent teeth*Osteopenia/Osteoporosis*Short Stature*Depression /Fatigue
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Dental Manifestations in CD
Dermatitis herpetiformis
Risk Factors for Celiac Disease
Prevalence among Risk factor those with risk factor (%)
Dermatitis herpetiformis 100First-degree relative with5 to 22 celiac diseaseAutoimmune thyroid disease 1.5 to 14Type 1 diabetes mellitus
Children 3 to 8Adults 2 to 5
Down syndrome 5 to 12Turner's syndrome 2 to 10
Diagnosis of celiac disease
SEROLOGY*Serum immunoglobulin A (IgA) endomysial antibodies and
IgA tissue transglutaminase (tTG) antibodies. Sensitivity and specificity > 95%.
*Testing for gliadin antibodies is no longer recommended because of the low sensitivity and specificity for celiac disease.
*Deamidated Gliadin Peptide [DGP]) may yield far higher diagnostic accuracy (sensitivity 94 %, specificity 99 %)
*The tTG antibody test is less costly because it uses an enzyme-linked immunosorbent assay; it is the recommended single serologic test for celiac disease screening in the primary care setting..
*Serologic testing may not be as accurate in children less than age five and is less accurate before age two.
*Confirmatory testing, including small bowel biopsy, is advised.
Normal small intestine
Celiac Disease Villous atrophy
Normal villi
*Multiple genes involved*The most consistent genetic component depends on the presence of HLA-DQ (DQ2 and/or DQ8) genes*One or both of these genes are found in 95% of celiac patients*Having one or more of these genes doesn’t mean you will develop celiac, but if you have the disease you likely have the gene.
HLA
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Gluten
Celiac Disease
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Genes
Genetics
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Normal small bowel Celiac disease
Gluten
Gluten-free diet
Treatment
* GLUTEN FREE DIET (dietician consult)
* Identification and treatment of nutritional deficiencies* Advocacy group* Pneumococcal vaccine
Take Home messages*CD is common. *IgA tTG -good screening test for CD. ( exceptions- < 2 years)*If CD is suspected, confirm by biopsy before initiation of gluten free diet. ( expensive and lifelong diet )*NCGS – may be common; more studies needed.