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					   Celiac Disease:
Autoimmune-mediated
    disease of the
gastrointestinal system

    Justin Nguyen and Megan Linders
              APA Format
 Introduction
•Celiac disease is an autoimmune disease of the gastrointestinal tract
•Characterized by an immune response to the glycoprotein gliadin found
in the protein gluten which is in wheat, rye, and barley
•The small intestine is affected. The villi atrophy and the mucosa of the
small bowel suffer from inflammation when gluten is ingested, making
nutrients absorption difficult
•About 1 in every 133 people in the U.S. suffer from Celiac disease;
approximately 3 million Americans live with Celiac disease
•Less than 4% of those who suffer are actually diagnosed
•Higher incidence in Caucasians and those with European ancestry,
people with diseases such as Type I diabetes, lactose intolerance, and
those diagnosed with other autoimmune diseases
•Celiac disease was described in three major events:
•Symptomatic :Aretaeus of Cappadocia in 250 A.D.
described symptoms that are typically for someone
suffering the disease
•Diet Based Correlation: Samuel Gee M.D. discovered in
1888 the disease was linked to the diet, and avoiding
certain foods curbed the symptomatic effects of the
disease
•Specific compound link: Willem Karel Dicke M.D. made a
relationship between wheat consumption and the disease.
 Disease Causation
• The causation of celiac disease is thought
  to have been originated from the T-cell
  recognizing the gluten protein as
  antigenic.(Catassi&Fassano, 2001)
• This recognition of antigenic material
  causes and initiation of an immune
  response leading to inflammation.
• This occurs within the small intestines,
  which causes damage to the villi and
  other structures in the small intestine,
  causing lack of absorption of nutrients.
  (Catassi&Fassano, 2001)
• More recent studies have lead to the idea
  that perhaps low serum IgA within the
  intestine of predisposed infants could
  also be a cause (Bianchi, 2010)
• Still uncertain, but genetic predisposition
  plays a role
 Symptoms
Symptoms include
   • Abdominal pain
   • Diarrhea/constipation
   • Fatigue/energy loss/ weakness due to
     malabsorption
   • Weight loss
   • Anemia
   • Skin alterations (Hin et al, 1999)
Diagnosis
There are several ways to test and diagnose celiac disease:
    • A physical examination for some of the following symptoms
         Hypotension
         Edema
         Dermatitis
         Skin Lesions
         Migraines
         Bone pain and tenderness, which may be caused by vitamin and
         mineral deficiency
    • Serology Tests
         Blood tests for several types of immunoglobulin like AGA,
         which is and immunoglobulin produced in the presence of
         gliadins.
Diagnosis continued
  • A biopsy of the small intestinal
    tissue
      This is to look for damage
      within the tissue, which is one of
      the symptomatic signs of the
      disease. Biopsy is generally the
      best diagnostic tool, and most
      commonly used.
  • A diet free of gluten, which is
    used as a marker, indicating
    whether the patient recovered as
    a result of the diet. (Green et al,
    2001)
  • An assessment of family history
    would also be beneficial in
    diagnosing the likelihood of
    Celiac disease.
Current
Treatments
• The only treatment that shows full reversal of symptoms
  would be adjusting to a gluten-free diet regimen, which
  would reduce the likelihood of contact with gluten to low
  levels. This generally poor solution for 30% of the Celiac
  population as many find it difficult to adhere to.
• For cases that are more severe, there are several types of
  corticosteroids that are used to lessen the more severe
  symptoms
  Clinical Trials and Current Research

• There are several research ventures that are being carried out
   • Testing for the gluten threshold level, trying to see the max
     amount of gluten that can be consumed by a person with celiac
     disease
   • Several studies are trying to make a more direct correlation
     between genetics and the disease
   • Research on the protein zonulin is being undertaken, with clinical
     trials being carried out. Researches have hypothesized that
     zonulin is produced in large amounts, which aids progression of
     the disease. What is being developed is a zonulin receptor
     antagonist, which would be utilized to prevent the production of
     zonulin, stopping the progression of the disease.
   • Study of correlation between Celiac disease and bone loss
  Conclusion/Future Studies

• For the future, celiac disease research seems to being going on the
  right track, finding relevant data on what makes celiac disease so
  debilitating, and beginning to find a treatment or even a cure for the
  disease.
• One of the primary goals is to discover the exact cause of Celiac
  disease to gain a better understanding of how to diagnose and treat
  patients
• The outlook, based on the studies, seems bright, though it will likely
  be some time before a major developmental plan is instituted to aid
  those suffering from the disease.
References

   Fasano, A., & Catassi, C. (2001). Current Approaches to Diagnosis and Treatment of Celiac Disease:
    An Evolving Spectrum. Gastroenterology, 120(3), 636-651.
   Murray, J. (1999). The widening spectrum of celiac disease. The American Journal of Clinical
    Nutrition, 9(3), 354-365.
   Green, P., Stavropoulos, S., Panagi, S., Goldstein, S., McMahon, D., Absan, H., et al. (2001).
    Characteristics of Adult Celiac Disease in the USA: Results of a National Survey . The American
    Journal of Gastroenterology, 96(1), 126-131.
   Bianchi, M. (2010). Inflammatory bowel diseases, celiac disease, and bone. Archives of Biochemistry
    and Biophysics, 503(1), 54-65. Retrieved from
    http://www.sciencedirect.com/science/article/pii/S0003986110002547
   Lindfors, K., Outi, K., & Laurila, K. (2010). Iga-class autoantibodies against neuronal
    transglutaminase, tg6 in celiac disease: No evidence for gluten dependency. Clinica Chimica Acta,
    412(13-14), 1187-1190. Retrieved from
    http://www.sciencedirect.com/science/article/pii/S0009898111001562

   Hin, H., Bird, G., Fisher, P., Mahy, N., & Jewell, D. (1999). Coeliac disease in primary care: case
    finding study. British Medical Journal, 318, 164-167.

				
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