Celiac disease - Research Paper Example

? Celiac Disease Celiac Disease Introduction Celiac disease is a pathological condition which affects the small intestine of an individual. It is an autoimmune condition which is led to by the response of the T cells against the cells of small intestine. This immune response occurs due to intolerance to gluten which is a protein that is present in wheat, barley and rye. It leads to atrophic changes in the villi of the small intestine which then affects the normal absorption of nutrients in the patient. The patient may present with pain in the abdomen, diarrhea, nausea and a reduction in weight. Anemia is also a common presentation (Longmore 2007). Current data trends and research Celiac disease is a well research pathological condition and this has led to make it known as “the best understood human “autoimmune” disorder.” Research studies have shed light upon the fact that one percent of the people in countries including Europe, South America and the United States have undiagnosed celiac disease. Current data also reveals that the presentation of symptoms of patients with celiac disease has also changed. Previously the patients mainly had weight loss, diarrhea and pain in the abdomen. But current diagnosis is mainly revealed when patients present with low Hemoglobin or they have symptoms which differ from the classical symptoms of celiac disease (Van and West 2006). Another interesting study on this condition highlighted that individuals with celiac disease previously were thought to be suffering from weight loss, but according to current research a significant number of patients having celiac disease are obese (Tuker et al 2012). Owing to the research activities carried out for celiac disease, this pathology has been thoroughly understood by the physicians and the patients who are now capable of dealing with this disease. The diseases that may result due to this condition have also been understood over time and the risks have been highlighted to increase awareness amongst the patients (Van and West 2006). The gluten free diet which is recommended for individuals suffering from celiac disease has also gained good marketing over the years. From a period where there were only a few options for the patients, an era has now come where many companies in the food market are generating gluten-free products. This has also led to a new research topic as many healthy people who do not have celiac disease claim that they become more energetic and active when they are on a gluten diet (O’ Brien 2011). Another important question which has arisen with regard to celiac disease is the lack of answers for the rise in the occurrence of celiac disease. Researchers are trying to reach to conclusions as to why the disease has increased over time at a very fast pace (Velasquez-Manoff 2013). Thus, celiac disease is a condition which is still being studied and there are still questions regarding the condition which need to be answered. History, epidemiology and evolution of the disease Celiac disease is a condition which has been persisting since many centuries. This condition was first hinted upon in the year 1888 by Samuel Gee who proposed the fact that changing the diet of the patients may be helpful. Despite of this, complete success for the treatment of this condition was not achieved until 1950. Wim Dicke presented the fact that removal of dietary substance like wheat, rye and oats led to improve the condition of the patients but a conclusion to the pathological changes as well as the identification of gluten was not achieved. The diagnostic breakthroughs were achieved in the year 1995 by Royer and in the year 1956 by Shiner. The Celiac Society identifying celiac disease was made in 1968. These steps were then followed and research breakthroughs in the condition were achieved over time (Losowsky 2008). The statistics of celiac disease have greatly increased over the years. The trends after 1974 in the United States have revealed that celiac disease prevalence has increased twice over every fifteen years. The University of Maryland's Mucosal Biology Research Center conducted this study which revealed that in 1974, the prevalence of celiac disease was one out of every 501 people. This increased to one in 219 people by the year 1989. The Celiac Research Center further revealed in another study that in the year 2003, these statistics rose and one out of every 133 Americans had celiac disease (University of Maryland Medical Center 2010). Systems of the body affected and how they are affected Celiac disease is mainly known to affect the gastrointestinal system of the body. The mucosa of the small intestine becomes intolerant to gluten. Upon exposure to gluten, there is recruitment of intraepithelial CD8+ T cells as well as CD4+ T cells. Inflammation of the intestinal mucosa results and atrophic changes in the villi develop. This affects the absorption of normal nutrients and hence the patient develops pain in the abdomen and mal-absorption (Kumar et al 2005). Dermatitis herpetiformis is the skin manifestation of celiac disease and this presents as blisters containing fluid. This skin lesion has the role of IgA as “granular IgA deposits” are found within these lesions. The blood system is also affected and due to the reduced absorption of iron from the small intestine, iron-deficiency anemia results. Fat soluble vitamin absorption also reduces and thus vitamin K deficiency is also noted in these patients that increases the susceptibility of bleeding (Coulston et al 2013). Populations that the disease targets Celiac disease is a condition whose prevalence has risen over the years. Three million residents of the United States suffer from celiac disease. In the African Hispanics and the Asian Americans the condition affects one out of every 236 individuals (University of Chicago 2005). The condition has a greater predisposition for females as compared to males and females are mainly diagnosed in their reproductive age. Another important aspect is that this disease affects adults more as compared to children. The disease targets a few races more than the others. The condition affects the white population more in comparison to any other race. It has been assessed that it is very uncommon amongst the blacks as well as the people of Chinese and Japanese origin. Studies conducted in Scotland amongst children revealed an interesting finding that the incidence of celiac disease had reduced in the children owing to the changes in the feed given during weaning. The cereals given to young children were commenced at later ages and this was linked with the reduced causation of celiac disease in these children in Scotland. This reveals the fact that early feeding of cereals raises the risk of development of celiac disease. The diabetic population also has a greater risk of being affected by celiac disease and this was reported by studies in Sweden as well as Italy (Shils and Shike 2006). Genetic or environmental factors and trends Celiac disease is a pathology which occurs due to the interplay of genetic as well as environmental factors. The genetic association of the disease is with the “human leukocyte antigen (HLA) genes of the major histocompatibility complex (MHC).” 95 percent of the individuals who suffer from celiac disease reveal the presence of HLA-DQ2 or HLA-DQ8 in their body. Non-HLA genes are also involved in the causation of this disease but a particular non-HLA gene has not been found though it has been assessed that they are mainly present on chromosome 5. The genetic role has been further enforced by studies on twins which identify the fact that 75 percent of the twins develop the condition simultaneously. First degree relatives of celiac disease sufferers also have a greater susceptibility to have celiac disease (Shils and Shike 2006). Environmental factors also have a role to play and gluten itself which is the main leading factor for this disease is an environmental agent. Total removal of gluten from the diet improves the condition. Another environmental factor which has been identified is human adenovirus. The resemblance in the structure of human adenovirus and gluten serves as a culprit in celiac disease (Rose 2005). Breast feeding is also an environmental factor for celiac disease and this practice is known to provide a shielding effect against celiac disease (Sanchez et al 2011). Treatment of the disease There are various steps in the management of celiac disease which should be followed. The first step after the diagnosis of the patient is the correction of the vitamin and mineral derangements in the patients followed by a strict advice to totally refrain from gluten. This means that wheat, rye and barley are prohibited products for these patients. The removal of gluten from the diet is the most significant step and it should be stressed upon by the physician. Dietary advice and counseling sessions are of utmost value for these patients. This is because during the initial phase after the diagnosis, many patients are not aware of the dietary restrictions and the risk of consuming substances containing gluten is high. Supplemental medications containing minerals and vitamins are to be administered in patients who do not have strict adherence. The patients should also be given regular checkups for the assessment of their weight and prognosis of the treatment given. This step is to ensure the fact that the health of the patient is improving on the basis of the diet. If despite of dietary restrictions the patient’s condition does not improve, corticosteroids as well as medicines which suppress the immune system can be administered (Colledge et al 2010). References Coulston, A. M., Boushey, C., & Ferruzzi, M. G. (2013). Nutrition in the prevention and treatment of disease. Amsterdam. Elsevier. Colledge, N. R., Walker, B. R., Ralston, S. H., & Davidson, S. (2010). Davidson's principles and practice of medicine. Edinburgh: Churchill Livingstone/Elsevier. Kumar, V., Abbas, A. K., Fausto, N., Robbins, S. L., & Cotran, R. S. (2005). Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders. Longmore, J. M. (2007). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Losowsky, M. S. (January 01, 2008). A History of Coeliac Disease. Digestive Diseases,26, 2, 112-120. O’Brien, K. (2011, November 25). “Should We All Go Gluten-Free?” The New York Times. Retrieved from http://www.nytimes.com/2011/11/27/magazine/Should-We-All-Go-Gluten-Free.html?pagewanted=all&_r=0 Rose, S. (2005). Gastrointestinal and hepatobiliary pathophysiology. North Carolina: Hayes Barton Press. Top of Form Sa?nchez, E., De, P. G., Capilla, A., Nova, E., Pozo, T., Castillejo, G., Varea, V., ... Sanz, Y. (January 01, 2011). Influence of environmental and genetic factors linked to celiac disease risk on infant gut colonization by Bacteroides species. Applied and Environmental Microbiology, 77, 15, 5316-23. Bottom of Form Shils, M. E., & Shike, M. (2006). Modern nutrition in health and disease. Philadelphia: Lippincott Williams & Wilkins. Top of Form Tucker, E., Rostami, K., Prabhakaran, S., & Al, D. D. (January 01, 2012). Patients with coeliac disease are increasingly overweight or obese on presentation. Journal of Gastrointestinal and Liver Diseases : Jgld, 21, 1, 11-5.Bottom of Form University of Maryland Medical Center. (2010). “UM School of Medicine Center for Celiac Research finds rate of celiac disease is growing.” E! Science News. Retrieved from http://esciencenews.com/articles/2010/09/27/um.school.medicine.center.celiac.research.finds.rate.celiac.disease.growing Van, H. D. A., & West, J. (January 01, 2006). Recent advances in coeliac disease. Gut,55, 7, 1037-46. Velasquez-Manoff, M. (2013, February 23). “Who Has the Guts for Gluten?” The New York Times. Retrieved from http://www.nytimes.com/2013/02/24/opinion/sunday/what-really-causes-celiac-disease.html?pagewanted=all Read More