Celiac disease is a disease found in the small bowel. This disease does not have a cure. It can only be treated with a strict diet. There are four types of celiac, and all but one can be treated. The disease is a genetically inherited associated with the HL4 locus found on the arm of the chromosome six (schaffner,small-bowel and bacterial overgrowth 2006 pg.99). This disease can cause a lot of problems with a patient if not treated properly. The proper treatment for most individuals is to go on a gluten free diet. A gluten free diet avoids wheat, rye, barley, and sometimes oats. Some symptoms are excessive diarrhea, smelly stools, cramps, and weight loss. The most accurate way to diagnose celiac disease is to do an upper endoscopy on the patient. An endoscopy is a procedure with a tube called a scope and a small camera on the end. The scope goes down the patient’s throat to look at their upper gastric region. A biopsy of jejunal mucosa would be done in the small intestine to send to pathology and determine if the patient has celiac disease. When a patient is on a gluten free diet and their body has not responded to it within two years they call this non-responders. Only five percent of individuals are non-responders. There is also called a refractory sprue this is when someone does not respond to the gluten free diet or has responded and over some time has slipped back and stopped working so the patient has the same symptoms as they did before. There are two types of refractory sprue. Type one is a normal population of intraepithelial lymphocytes. Type two is an premalignant population of intraepithelial lymphocytes based upon clonality analysis of t-cell receptors and immunophenotyping. Type one can never lead to type two, a patient either has one or the other. Type one also has a higher survival rate of a five year study. This disease is a slowly growing disease. Now we find in some areas in the populations that it can be higher than one in two hundred and fifty people.
Celiac disease is a digestive condition triggered by consumption of the protein gluten. Many individuals will experience an immune reaction to the gluten that is digested. These proteins are mainly found in bread, pasta, and many different foods that contain wheat, barley and rye. Some foods that contain gluten that are over looked are brown rice syrup, energy bars, imitation seafood, processed luncheon meats and many more. When we experience a patient that doesn’t obey the gluten free diet they could do cause damage to the inner surface of the small intestine and not have the ability to absorb certain proteins that the body needs. There are four types of celiac disease. Type one has an increase in T- cell receptor intraepithelial lymphocytes. The symptoms of this type are malnutrition and weight loss with no symptoms of gastrointestinal symptoms. Type two has enlarged crypts along with the intraepithelial lymphocytes. Type one and two are the only types that can be treated. Type three is present in all symptomatic patients, but many patients with this lesion are asymptomatic. Type four is irreversible and is found in patients who do not respond to gluten withdrawal and in patients with lymphoma (schaffner,small-bowel and bacterial overgrowth 2006 pg.100). The one way to diagnose a patient with celiac is to do an upper endoscopy and take a biopsy. To get the most accurate diagnosis is to biopsy the jejunal mucosa in the small intestine. They can also do serologic testing. It tests the IgA antigliadin antibody levels. They mostly use this test to see if the gluten free diet is working. Patients with celiac disease have a higher chance of lymphoproliferative disease and gastrointestinal then the average person. Studies have proven that a person with celiac is more likely to develop other autoimmune disorders like type one diabetes mellitus, and connective tissue disease. Mothers that have not been diagnosed with the disease could have...
References: Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www.uptodate.com
Greenberger; Blumberg; Burakoff; current diagnosis & treatment;2009; McGraw Hill companies
Hauser, MD; pardi, MD; Poterucha MD; mayo clinic gastroenterology and hepatology board review, second edition;2006
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