Download Celiac Disease

Running head: CELIAC DISEASE
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Celiac Disease
Diana VanRhee
Ferris State University
English
321
Rick Amidon
April 15, 2013
CELIAC DISEASE
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Table of Contents
Page 3. Abstract
Page 4. Introduction
Page 5. Prevalence of Celiac Disease
Page 5. Symptoms
Page 6. Diagnosis
Page 7. Types of Celiac Disease
Page 7. Management
Page 8. Medications
Page 9. If Left Untreated, Then What?
Page 9. Summary
Page 11. Glossary
Page 12. References
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Abstract
This paper defines celiac disease (CD) and how it is commonly diagnosed. It reveals that
in the past, it was common for a person to go years before receiving a proper diagnosis. It also
reviews the history of CD, symptoms, treatment and who is affected by it. In this paper, you will
find information on managing CD and the importance of it, along with some resources available
to an individual who is newly diagnosed.
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Celiac Disease
Introduction
Celiac disease (CD) or Celiac Sprue is clinically defined as “a multisystem disorder that
causes the body’s immune system to respond to the protein in certain grains.”(Bower, Sharrett, &
Plogsted, 2007, p. 2). There are several protein complexes which are found in a variety of grains.
Gliadin, a protein complex found in wheat type grains, horden is in barley type grains, and rye
contains secalin. (Bower et al., 2007) Gluten is common in all three of these grains and will
cause an allergic reaction, an autoimmune response from the body. The reaction from the
immune system causes damage to the lining of the small intestine, otherwise known as CD.
(Celiac Disease, 2007). Gluten can be found in other grains, such as corn, although that will not
cause any ill effects on a person with CD. In an autoimmune response, the immune system over
reacts and works against itself. The small intestine has villi (small finger like projections), that
help food and nutrients to be absorbed. In a person with CD, they eat gluten and these villi lay
flat or are missing entirely. (Burns, 2008). So the food, when digested, will not be absorbed into
the body, losing the nutritional value and is shipped out of the body at an accelerated pace.
In the last decade, people started hearing the terms “gluten intolerance”, “glutensensitive”, or even wheat allergy. Does this mean that CD is a new disease? Prior to 2000, the
general public had a perception from the medical world that CD was a “rare disorder afflicting
children with severe diarrhea and failure to thrive, and where clinical improvement on a gluten
free diet led to a diagnosis (Burns, 2008, Foreword 1, 2008). It was said in 250 A.D. that Aretaus
of Cappadocia used a term “koiliakos”, meaning “suffering of the bowels” for symptoms that
doctors now believe is CD. Also, in 1888, Samuel Gee, MD viewed some clinical accounts of
adults and children who presented with gastro-intestinal symptoms such as bloating, gas and
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diarrhea. A few decades later, in 1954, Willem Karel Dicke, MD linked ingestion of wheat
proteins as the cause of CD and he related it to small bowel change.
(www.csaceliacs.org/info/history_of_celiac_disease.jsp, 2013). Dr. Stephen Friedl, MD, DO, has
been practicing for nearly 20 years in endoscopy and surgery. He believes that there has been an
increase in the diagnosis of CD due to the more accurate serology testing and the biopsies
performed of the small intestine. “In the past, endoscopy was done to observe the lining of the
small intestine, whereas nowadays, a biopsy is almost always included.” (S. Friedl, personal
communication, April 9, 2013)
Prevalence of CD
The human body is wonderful, complex and yet can be mysterious at times. So, how does
one acquire CD? CD is a genetic disorder, so it tends to run in families and certain ethnic groups.
(Burns, 2008). “Humans inherit one set of genes from each parent. Celiac disease is associated
with two genes, HLA-DQ2 and HLA-DQ8. To have CD, you must inherit either or both of these
genes from your parents” (Burns, 2008, p. 7). While European ancestry is the primary targeted
population, Irish, Canada, Italian, Sweden, Finish and Indian also have higher rates of CD.
Interestingly enough, research shows that it is rare for non-Caucasian ethnic groups to be
diagnosed with CD. However, there have been cases in Sudanese, Cantonese, Hispanic, Israeli,
Jew and Arab, although it is not common. (Burns, 2008)
Females will be diagnosed at a rate of 1.5-2.1 times more than males, with the median
age being in the 40’s. This data could be hindered, because females generally seek medical
attention more than males. (Burns, 2008).
Symptoms
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Symptoms vary from person to person. An individual can have a variety of vague
symptoms that are multisystem related. Often patients will see the advice of several physicians,
over the course of several years, which sometimes leads to misdiagnosis. Lin, a current patient
with CD saw several different doctors over the course of ten years, before being referred to a
gastroenterologist. A positive serology test and a positive small intestine biopsy revealed her
diagnosis of CD. (L. Deboer, personal communication, April, 2013).
The most common symptoms of CD are anemia, fatigue, bone and joint pain, abdominal
cramping and bloating, diarrhea and dermatitis herpetiform (an itchy rash). Although there are
many more symptoms, only these will be addressed in this paper.
Anemia is a low blood level that is directly related to mal absorption of nutrients in the
small intestine. When a person is anemic, they suffer from fatigue and malaise, which is just a
general feeling of discomfort or illness. Both of these symptoms are prevalent in a host of other
diseases, which is one reason why CD cannot be diagnosed by symptom alone. (Burns, 2008).
Abdominal bloating, gas and diarrhea often go hand in hand. They are also common in
other intestinal diseases, such as Irritable Bowel Syndrome. The difference in CD is that the villi
in the small intestine are lying flat or are missing. This can only be detected with an endoscopy
and biopsy of the small intestine,
Dermatitis Herpetiformis (DH), is sometimes called CD of the skin. It causes intense
itchy dry skin that blisters. Often, due to the scratching, the blisters are popped and gone by the
time a patient seeks medical attention. (Bower et al., 2007)
Diagnosis
As you can see, it is difficult to diagnose a patient on symptoms alone. Research and
evidence is overwhelming that the gold standard testing is a small bowel/intestine biopsy. This is
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a minimally invasive endoscopic procedure where a biopsy (a small sample) of the tissue is taken
from the intestine. The villi will be looked at under a microscope to determine if CD is present or
not. If it is present, the normally finger shaped villi will be shortened, flattened or not present.
Serology, meaning the study of the blood serum, is done to test for the presence of
several antibodies. A patient needs, yes, NEEDS, to be eating a regular diet containing gluten for
4 weeks prior to the serology testing. When gluten is present in the body, the auto immune
system fights, thus elevating the levels of Antigliadin Antibody (AGA), Antiendomysial
Antibody (EMA) and Tissue Transglutaminas Antibody (tTG). (Bower et al., 2007).
Types of Celiac Disease
“CD can be classified in four categories:
1. Classic CD - Manifests with atrophy of the villi, weight loss, diarrhea and
bloating
2. Atypical CD – Manifests without the typical gastrointestinal symptoms
3. Undiagnosed CD – Patient has classic symptoms, but is not yet diagnosed.
Eventually a diagnosis of CD is made
4. Silent DC – The absence of symptoms in an individual that has had a positive
small bowel biopsy and positive serology testing “(Burns, 2008, p. 19-20).
Management
Okay, so now you have a positive diagnosis of CD, now what? Eliminating gluten from
the diet will alleviate the symptoms, but it will take time to rebuild the blood supply and
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replenish the lost nutrients. An individual must be diligent in their gluten-free (GF) diet. (Bower
et al., 2007). This can be challenging, because gluten is found in many manufactured products.
An appointment with a dietician is essential and should be a priority. A GF diet excludes wheat,
barley and rye. A food is labeled GF when a “food contains fewer than ten parts gluten per
million parts product.”(Burns, 2008, p. 109) ns, 2008). Fresh fruits and vegetables, potatoes,
unprocessed meats and most dairy products, such as eggs, milk and hard cheese are naturally GF.
If a product is not labeled GF, it could be manufactured in a factory that makes gluten products,
thus causing cross contamination that could be harmful for the individual with CD. (Celiac
Disease, 2007)
This acronym does a great job at describing CD and acts as a reminder to us all.

Consultation with a skilled dietician

Education about the disease

Lifestyle adherence to a gluten-free diet

Identification and treatment of nutritional deficiencies

Access to an advocacy group

Continuous long-term follow-up by a multidisciplinary team (Bower et al.,
2007, p. 80)
Reading labels is a must! Becoming educated about CD and educating your family and
friends is a key component in leading a GF lifestyle. “Celiac disease is a permanent
disease….however, if you change your habits and adopt a gluten-free lifestyle, you can reverse
the damage associated with celiac disease.” (Celiac Disease, 2007, p. 2)
Medications
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There are medications available both over the counter and by prescription. These will not
cure CD, but help to manage some of the symptoms when you have a flare up. Over the counter
medications include Miralax and gluten-ease. Gluten-ease is a digestive enzyme that when taken
with a gluten containing food, will minimize the abdominal discomfort and help break down
gluten. (L. Deboer, personal communication, April, 2013). Steroids can be prescribed by your
doctor and help with the inflammation of the digestive tract. Inflammation is where a part of the
body is reddened, swollen, hot and often painful. (Burns, 2008)
There are a variety of support groups available, along with a wealth of knowledge
available on the internet. The following websites are reliable www.csuceliacs.org and
www.celiac.org (The Celiac Disease Foundation).
If Left Untreated, Then What?
When a patient is left untreated after being diagnosed with CD, further damage to the
intestinal tract is likely to occur along with continued nutritional deficiencies are to be found.
(Celiac Disease, 2007). According to the Celiac Sprue Association, “undiagnosed CD increased
the risk of cancer by 200%- 300%.” (McCabe et al., 2012, p. 8).
“The relationship between Celiac Disease and cancer is well established and has
been described in the medical literature for years. There is a well-known
association between Celiac Disease and cancer of the head and neck, esophagus,
adenocarcinoma of the small intestine, and lymphoma. Many types of lymphoma
are related to abnormal cell types; the version seen in conjunction with Celiac
Disease is called enteropathy-associated T-cell lymphoma (EATL). (Burns, 2008,
p. 174-175).
Summary
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Celiac Disease is not a new fad disease or a catch all medical term. It is a serious medical
condition, that when properly diagnosed and treated, can be managed and the damage repaired.
Although research has increased by more than 100% in the last five years alone, more needs to
be done. (Bower et al., 2007). By taking ownership of their health, adhering to a strict GF diet,
educating themselves and their loved ones, patients will be able to manage their new GF
lifestyle. “Healing is a state of mind that needs to be nourished and cultivated. Hope is the
central path of healing.” (Bower et al., 2007, p. 95)
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Glossary
Adenocarcinoma- a form of cancer that forms on glands
Anemia- low blood count or low blood levels
Atrophy- to waste away
Autoimmune disease- a disease where the body attacks itself and causes damage
Biopsy- removing a tissue sample
Dermatitis Herpetiform- intense, itchy rash with tiny blisters
Endoscopy- minimally invasive procedure using a light and scope to obtain tissue samples
Gastroenterologist- a doctor who specializes in treating diseases of the liver, stomach, intestine,
pancreas, esophagus and who performs endoscopic procedures
Inflammation- part of the body that becomes reddened, swollen, hot and often painful
Lymphoma- cancer of the lymph nodes
Malabsorption- inadequate nutrition caused by impaired food absorption
Malaise- feeling of discomfort or illness
Serology- study of blood serum related to immune studies
Small Intestine- part of the digestive tract where food is digested and nutrients are absorbed
Villi- fingerlike projections found in the small intestine and aid in digestion and absorption of
food
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References
Bower, S. L., Sharrett, M. K., & Plogsted, S. (2007). Celiac Disease: A Guide to Living with
Gluten Intolerance. New York, NY: Demos Medical Publishing, LLC.
Burns, D. L. (2008). 100 Questions and Answers about Celiac Disease and Sprue: A Lahey
Clinic Guide. Sudbury, MA: Jones and Bartlett.
McCabe, M. A., Toughill, E. H., Parkhill, A. M., Bossett, M. S., Jevic, M. S., & Nye, M. L.
(2012, October). Celiac Disease: A Medical Puzzle. AJN, American Journal of Nursing,
112(10), 34-44. http://dx.doi.org/10.1097/01.NAJ.0000421019.77542.65
Understanding Celiac Disease [consumer brochure]. (2007): AGA Institute.
www.csaceliacs.org/info/history_of_celiac_disease.jsp. (2013).