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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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