Something about celiac disease
Celiac disease is an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine and the only treatment is a lifelong adherence to a gluten-free diet.
Celiac sprue, also known as celiac disease or gluten-sensitive enteropathy, is a chronic disorder of the digestive tract (small intestine’s inflammation) that occurs in genetically predisposed people of all ages from different parts of the world. However the population with conditions such as diabetes, autoimmune disorders or related pathologies have even higher risk for the development of this disorder.
WHAT GLUTEN IS?
Celiac disease is caused by the ingestion of GLIADINS, a class of proteins present in the endosperm of mature wheat grain and several other cereals (rye, barley, kamut, oats, etc.). It is one of the main component of GLUTEN along with GLUTENINS (gluten is split about evenly between the gliadins and glutenins, although there are variations found in different sources).
Gliadin contributes to extensibility while glutenin contributes to the elastic character of gluten.
A balance between elasticity and extensibility (gluten strength) is necessary for superior baking performance.
Gluten is formed during the mixture between water and flour; during mixing, a continuous network of protein forms, give the dough its strength and elasticity.
By holding gas produced during fermentation, the protein network allows bread to rise. It also allows the dough to maintain its shape. These two functions of the protein network are what give bread its chewy texture.
When patients with celiac disease ingest gliadins, an immunologically mediated inflammatory response occurs that damages the mucosa of their intestines.
Gliadin gains access to the basal surface of the epithelium where the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts directly with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy) which is resulting of maldigestion and malabsorption of food nutrient.
WHAT ARE THE SYMPTOMS?
Individuals who have this disorder may present gastrointestinal symptoms, extraintestinal symptoms or no signs of symptoms.
The classical symptoms include gastrointestinal-related symptoms such as pain and discomfort in the digestive tract, chronic constipation and diarrhea, failure to thrive (in children), anemia, fatigue and weight loss due to malabsorption (vitamin deficiencies are often noted in people with celiac disease owing to the reduced ability of the small intestine to properly absorb nutrients from food).
About 50% of celiac patients present extraintestinal or atypical symptoms, such as anemia, osteoporosis, dermatitis herpetiformis, neurological problems and dental enamel hypoplasia.
The variable clinical picture of celiac disorder is due to having both genetical and immunological bases, with age of onset, extent of mucosal injury, dietary habits, and gender, affecting the clinical manifestation of the disease.
WHAT IS THE DIAGNOSIS?
Celiac disorder diagnosis is based on presence of predisposing genetic factor human leukocyte antigen with positive biopsy and serological antibodies upon gluten contained diet.
The spectrum of this disorder may present in different forms:
- The classical form may be diagnosed at any age of life and is often characterized by crypt hyperplasia and villous atrophy along with features of malabsorption.
- The atypical form is characterized by positive celiac serology, limited abnormalities of the small intestinal mucosa or no intestinal symptoms, but associated extraintestinal conditions such as osteoporosis, peripheral neuropathy, anemia and infertility.
- The latent form is defined by presence of predisposing gene, normal intestinal mucosa and, possible positive serology. Extraintestinal features and biopsies of the small bowel can show alterations with gluten intake (i.e., gluten-sensitive).
Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting, for mistake, small amounts of gluten, like crumbs can trigger small intestine damage.
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- Troncone R, Jabri B. Coeliac disease and gluten sensitivity.J Intern Med.2011;269:582–590.
- “SOD/Gliadin Defense Against Disease and Aging”.Total Health 25 (3): 14. 2003.
- Rampertab SD, Pooran N, Brar P, Singh P, Green PH.Trends in the presentation of celiac disease. Am J Med 2006;119: 355.e9-355.14
- Bai D, Brar P, Holleran S, Ramakrishnan R, Green PH.Effect of gender on the manifestations of celiac disease:evidence for greater malabsorption in men. Scand J Gastroenterol 2005; 40: 183-187