Celiac disease- Causes, symptoms, investigation, management

Celiac disease is also known as many names like nontropical sprue, or celiac sprue, adult celiac disease, and gluten-sensitive enteropathy, is an inflammatory disorder that is an immunologically mediated disorder of small bowel, it occurs in the genetically susceptible individual and resulting from intolerance to wheat gluten and similar protein found in rye, barley.

Celiac disease causes malabsorption and it responds to a gluten-free diet.

The characteristic of celiac disease is the presence of an abnormal small intestine biopsy and the response of both symptoms, evidence of malabsorption, and the histopathologic changes on the small intestine biopsy, the celiac disease responds to the elimination of gluten from the diet.

Causes of celiac disease:

The exact mechanism of celiac disease which leads to damage to the mucosa is still unclear, but there is evidence for an immunological response to gluten which plays the main role. Tissue transglutaminase (TTG) is recognized as the autoantigen for anti-endomysial antibodies which is often used in serological diagnosis.

Symptoms of celiac disease:

1. Celiac disease can occur at any age, in infancy, it occurs after weaning on cereals and presents with diarrhea, malabsorption, and failure to thrive.
2. Diarrhea in some and constipation in some, excessive gas.
3. Itchy rash on the skin.
4. In older children with celiac disease, there is delayed growth also.
5. Features of malnutrition and mild distention of the stomach.
6. Growth and pubertal delay lead to short stature in adulthood.
7. In adult individuals, celiac disease has an onset in the ’50s, the presentation depends on the extent of involvement of the small bowel.
8. Some individuals show florid malabsorption while some other individuals develop nonspecific symptoms like tiredness, weight loss, deficiency of folate, or iron deficiency anemia.
9. Oral ulcers, dyspepsia, and bloating in the abdomen are also present.

Celiac disease is also associated with many diseases like; insulin-dependent diabetes mellitus, thyroid disease, down syndrome, ulcerative jejunitis, pernicious anemia, etc. There is frequently a spontaneous remission during the ’20s of life, which may be permanent or followed by the reappearance of symptoms after several years. Flare-ups and remissions are common in celiac sprue.

The symptoms range from malabsorption of multiple nutrients to diarrhea, steatorrhea, and loss in weight and there is a result of nutrient depletion like anemia and metabolic bone disease.

Investigations for celiac disease:

1. Serum antigliadin (IgA) and anti-endomysial antibodies are found in untreated cases.
2. Full blood count and levels of calcium, magnesium, total protein, albumin, and vitamin D must be assessed.
3. Duodenal and jejunal biopsy.

Management:

1. To correct the deficiency of iron, folate, calcium, and vitamin D.
2. A gluten-free diet: Includes herbs, vegetable oils, butter, arrow roots, amaranth, seeds (flax and chia seeds), nuts, nut flours, corn, and cornflour, potato, soy food, coconut, and tapioca, spices, oats (only if labeled as gluten-free) rice, bean, sorghum, buckwheat, millet, all fruits, and vegetables, eggs, milk, yogurt, and cheese, fish and meat (not coated), tea, coffee, fruit juice (without added flavors)
3. Flour to eat: flour of chickpeas, tigernut, almond, buckwheat, amaranth, arrowroot, brown rice flour, coconut, corn, teff, and tapioca.
4. Not to eat: Wheat-based bread and pasta, wheat starch, wheat germ, wheat bran, baked products, Triticale, barley, Dinkel wheat or hulled wheat, roasted nuts, Khorasan, candy, Brewer’s yeast, flavored chips, soy sauce, marinades, salad dressings, flavored alcoholic beverages, and beer, processed meat, cooking spray, oils with additives, flavored dairy products, lactose rich food, as lactose intolerance are common in celiac disease.

Prognosis and complications:

1. Increased risk of enteropathy associated T cell lymphoma, small bowel carcinoma, and squamous carcinoma of the esophagus.
2. Ulcerative jejunoileitis may present, which ultimately leads to perforation.
3. Metabolic bone disease is common in poorly controlled celiac disease.
4. Complications are reduced in those who strictly follow a gluten-free diet.

How to get rid of pain after being glutenated?

• If there is the presence of diarrhea, then we must correct the electrolyte imbalance by using a half teaspoon of common salt and a six-level teaspoon of sugar.
• Activated charcoal, is available in medical stores.
• Mint, coconut water, bone broth.
• Turmeric and ginger.
• Gluten-free food.
• Fermented foods like yogurt avoid lactose-containing food.
• Peppermint tea, a gluten-free probiotic.
• Plenty of water.
• Pineapple juice (fresh only no additives packaged one).
• Adequate rest.