Presentation by Margaret Roberts. First described in 1880 Link to diet was not described until...

Celiac disease: No cake for you!

Presentation by Margaret Roberts

First described in 1880

Link to diet was not described

until 1950

In 1954, Dr. Paulley showed that

intestinal mucosa was damaged

History of celiac disease

Walker and Murray 2010

Autoimmune Disease

Response to barley, wheat, and rye

It can affect the gut, skin, joints, uterus,

brain, heart, and other organs

1 in 100 have celiac disease

Celiac Disease


Requires a joint clinicopathological approach

First-line test is serology with

immunoglobulin A (IgA) tissue

transglutaminase and IgA endomysial

antibodies. Second, biopsy is the best to confirm the

diagnosis of celiac disease

Diagnosis


While the sensitivity of IgA to detect celiac

disease is 91%, this test has a positive

predictive value of only 29%◦ In one study up to one in 13 cases of celiac disease

were undetected by serology IgA deficiency is the most common primary

immune deficiency, affecting one in 400 to one in 600 of the general population, and a high proportion of those tested for celiac disease

Serology


Biopsy should occur in the duodenum, preferably the

second portion of it.

Duodenal bulb is a secondary location

Suggested that biopsies should occur four to five times

before true diagnosis can be made

Biopsy

Classical scalloping of duodenal mucosa seen in established celiac disease at endoscopy.


Normal versus Celiac small bowel biopsy.

Top: Normal small bowel biopsy with finger-like villi.

Bottom: Celiac small bowel biopsy with villous atrophy and hypertrophy of crypt.

Martin 2008

Nausea, Diarrhea, vomiting

Irritability, fatigue

Itchy rash over arms, elbow, scalp, face and

knees

Lactose intolerance, infertility, depression,

and elevated liver enzymes

Symptoms of CD

Martin 2008

Have a three-fold higher risk of non-Hodgkin

Lymphoma as well as cancer of the gastrointestinal

tract. Lower risk of postmenopausal breast cancer

because of lower obesity rates.

Iron deficiency anemia is also prevalent due to

malabsorption

Worse cases have megablastic anemia because of

B12 deficiency

Side effects of CD

Martin 2008

Introduction to complementary foods too

soon

Introduction to complementary foods too

late

Use of formula instead of breast milk

Genes

OR … A combination of the four?

Possible Causes:

Early in life, the body is building up immune

functions as well as proper responses to food

Without the proper enzymes to digest a food, the

body treats it like an antigen/allergen

Allergen exposure too early when the gut

colonization and local immune networks are less

established may increase the risk of allergic or

autoimmune disease

Introduction of Complementary foods too soon

Prescott, Smith, Tang, Palmer, Sinn, Huntley, Cormac et. al 2008

Evidence that waiting until after six months to introduce complementary foods increases food allergies

Instead, there is a critical period during which complementary foods must be introduced

Animal studies suggest this age to be 4-6 months

Introduction of complementary foods too late

School of Pediatrics and Child Health Research 2008

Studies show that breast feeding at least

delays the onset of celiac disease

Continued breastfeeding promotes

tolerance and have protective effects during

the time when complementary feeding is

initiated.

Use of breast milk vs. formula

Breast milk may limit amount of gluten absorbed

Prevention of gastrointestinal infections by breast milk

Human milk IgA antibodies may diminish immune response to ingested gluten

The immune modulating property of human milk may be exerted through its T-cell specific suppressive effect.

Celiac disease and breast milk

Selimoglu, Mukadder Ayse MD; Karabiber, Hamza MD 2010

VERY strong correlation

Virtually all patients carry human leukocyte

antigen (HLA)-DQ2 or HLA-DQ8

The absence of these molecules has a

negative predictive value for celiac disease

close to 100%.

Genes


The best treatment is a gluten-free diet.

This has a near 100% chance of relieving

most, if not all symptoms

Unfortunately, sticking to the diet is very

hard

Also, gluten-free diet is correlated with

anger, sadness, and despair

Treatment


Enzyme supplement treatment◦ Lack of endoprolyl peptidase (PEP)◦ Administration of enzymes with meals can

complement gastric and pancreatic enzymes in detoxification of ingested gluten

Designer carbohydrates◦ The aim is the production of wheat that is devoid

of biologically active peptide sequences Correction of impaired Intestinal

permeability

Newest treatments


Martin, S. (May 2008). Against the grain: an overview of celiac disease. Journal of the American Academy of Nurse Practitioners. 20(5),243-50

Selimoglu, Mukadder Ayse MD; Karabiber, Hamza MD (January 2010). Celiac disease: prevention and treatment. Journal of Clinical Gastroenterology. 44(1), 4-8.

School of Pediatrics and Child Health Research. (2008 August). The importance of early complementary feeding in the development of oral tolerance: concerns and controversies. Pediatric Allergy and Immunology. 19(5), 375-80

Walker, M. Murray, J. (3 November 2010). An update in the diagnosis of coeliac disease. Histopathology. Obtained from PubMed.gov.

Works Cited

Presentation by Margaret Roberts. First described in 1880 Link to diet was not described until...

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