Celiac Disease - Pathophysiology and Treatment Options - Research Paper Example

Celiac Disease al Affiliation Celiac Disease Thompson (2006) s that a celiac disease is one of the most common genetic health disorders in the United States. Celiac disease is a genetic autoimmune health condition that causes corrosion on the walls of the small intestine whenever an individual consumes foods with gluten. Since the disease damages the walls of the small intestines, it becomes difficult for patients with celiac disease to absorb food nutrients. Estimates indicate that about one in every 133 individuals in America is suffering from celiac health disorder (National Foundation for Celiac Awareness, 2014). This translates to about 1% of the U.S. population who are living with celiac disease. However, experts believe that the prevalence could be higher since about 83% of Americans who live with the disease are either undiagnosed or misdiagnosed with other health problems. The disease is not easily diagnosed within the first few years of infection. Dickson, Streutker and Chetty (2006) note that it takes about 6-10 years for a patient to be diagnosed with the disease. This implies that the patient is diagnosed when the disease has eaten the small intestines for a very long time. Celiac disease affects both men and women alike. In addition, the prevalence of the disease cuts across all races and age groups in the United States. Pathophysiology Celiac disease is a multisystem health condition resulting from genetic, environmental and immunologic exposure to gluten. Genetic According to Dickson, Streutker and Chetty (2006), almost all patients with the celiac disease have HLA DQ2 haplotype while between 5 percent and 10 percent of patients with the disorder have DQ8 haplotype. The haplotypes are found within a patients HLA class II region of chromosome 6p. Although the majority of those with hypotypes are diagnosed with the celiac disease, about 40% of people with the haplotypes never suffer from the disease. This implies that the presence of the haplotypes in the body is not necessarily that bad after all. Apart from haplotypes, researchers are also investigating the influence that non-HLA genes have on the development of the disease. Because celiac is a genetic health disorder, the disease can spread within a family. The National Foundation for Celiac Awareness (2014) report shows that between 5-22% of patients with the disease have family members who also suffer or have suffered from the disease in the past. Environmental Environmental exposure also increases the risk of developing the celiac disease. Researchers have noted that the risk of developing the disease increases with an intake of gluten in the diet. In this regard, the researchers have shown that feeding infants below four months of age diets with gluten increases the risk of such infants of developing the celiac disease (Barker and Liu, 2008). Certain grains have been shown to contain protein nutrients that are capable of forming gluten, resulting in the development of the celiac disease. Some of these grains include wheat, rye and barley. Therefore, parents are advised against feeding infants large quantities of these grains. However, other grains such as rice, millet and sorghum are safe because they do not activate gluten, which is responsible for causing celiac disease. Immunologic Researchers have also cited that the risk of developing celiac disease increases when a susceptible person exposes his upper small bowel mucosa to gluten. Dickson, Streutker and Chetty (2006) reveal that such exposures trigger an immune-mediated response in the body, resulting in the development of the disease. Signs/Symptoms There are quite a number of signs and symptoms, which manifest whenever a patient is suffering from celiac disease. The first major problem is digestive problems. Since the disease attacks the small intestine that is concerned with the digestion and absorption of food, patients with celiac disease normally experiences difficulties in digesting food. This is normally accompanied by diarrhea, abdominal pain, paleness of the fesses, gas and weight loss. Secondly, patient with the disease normally experiences gradual development of skin rashes, commonly known as dermatitis herpetiformis (Green and Jones, 2010). Thirdly, children who develop the disease at the tender age usually experienced retarded growth. Green and Jones (201o) reveal that the majority of children with the disease hardly grow above five inches tall. Fourthly, patients with celiac disease tend to experience iron deficiency, which result in anemia. Fifthly, patients with celiac disease normally pain of the joint, tingling feelings in the legs, seizures and sore mouth. Additionally, the majority of women with the condition usually experiences missed menstruation. Progression Trajectory Celiac disease is not a fatal disease. However, patients are advised to seek treatment early enough to prevent the disease from progressing to other parts of the body. Research shows that the celiac disease can progress and affect other body organs if left untreated. This is dangerous to the health of the patient since it might result in the development of nutritional deficiencies and other severe health complications. Diagnostic Testing Diagnosis of celiac disease normally follows certain critical steps. Therefore, in case a patient is suspected of having developed celiac disease, the first clinical procedure to diagnose the disease is to examine the a patients medical history. This includes determining whether a patient has a close relative who have been diagnosed with celiac disease among other tests (Barker and Liu, 2008). Secondly, if suspicion exists, a doctor will proceed to test if the patient in question has the celiac serology antibody. Once the test has been done, the doctor may also perform a biopsy for the patients small bowel to see if the patient has the celiac disease. Experts advise that patients should be provided with a diet containing gluten during testing. The disease may also be diagnosed by performing other tests, such as the blood test to determine if the patient in question has a nutritional deficiency. The tests include investigating the level of iron, which might decrease if the patient is suffering from celiac disease (Green and Jones, 2010). Other diagnostic tests for celiac disease include testing a sample of patients stool to see if the stools have traces of fat. This is because the presence of the disease makes fat absorption difficult. Treatment Options Celiac disease is treatable. In fact, there are a number of treatment options available for celiac disease. The first treatment method for celiac disease is total lifestyle change. This implies eating healthily and regularly exercising. As aforementioned, eating diets with gluten is one of the greatest risk factor for celiac disease. Therefore, doctors recommend that patients with the disease should refrain from eating diets containing gluten (MIMS, 2006). Eliminating gluten from diets has been proven effective since it helps improve a patients condition within few days after elimination. Eventually, the symptoms of the disease disappear, and the patient begins to live a life free of the disease. According to Barker and Liu (2008), it takes about six months for the small intestine to heal after the stoppage of the gluten diets. Health professionals advise that, once a patient has stopped intake of gluten diets, they should do so without stoppage; otherwise the patient will experience a relapse of celiac disease. However, for patients whose small intestines have been damaged, such patients can be treated well by giving them nutritional supplements. This is because merely stopping gluten diets cannot help heal the damaged intestines. Physical and Psychological Impacts of Celiac Disease on Patients and Parents Celiac disease like most other disorders manifests itself through psychological problems in patients. Dickson, Streutker and Chetty (2006) reveal that patients with celiac disease usually experiences problem with their emotions. This usually results in depression and anxiety, which impacts negatively on the health of such patients. Some of the depressive symptoms commonly observed in patients with celiac disease include irritability, loss of appetite, fatigue and sleep problems. Additionally, the majority of patients suffering from celiac disorder are usually impatient, get angry quickly while others experience mood swings. Patients also develop physical complication, including fatigue, numbness and weight loss and moving difficulties. Parents of patients suffering from celiac disease also under psychological trauma that impact negatively on their health. Taking care of the sick is usually challenging to most families. Therefore, whenever a family member is diagnosed with celiac disease, most family members find themselves in the feeling of grief and sorrow. As a result, families may also develop depression (Green and Jones, 2010). Some families may also suffer from stigmatization from the members of the society. The Key Concepts, Which Must Be Shared With the Patient and Family to Achieve Optimal Disorder Management and Outcomes. The involvement of patients and their families in disease management is key to achieving optimal outcome. However, in order to achieve optimal disorder management and outcome, health care providers must share certain key concepts. The first concept is dignity and respect. In this case, health care providers are expected to not only listen to the patient and family views in planning and delivering care to patients. Second concept is information sharing (Barker and Liu, 2008). In this case, health care providers are expected to share with patients all information that may be useful to patients and families in administering care. The information must be unbiased, accurate, and timely to ensure active participation of patients and their families in care and decision-making. Forth concept is participation. In this case, health care providers must support and encourage the participation of patients and their families in care and decision-making at whatever level they choose to optimize care delivery and outcome. Lastly, health care providers must collaborate with patients and families in the development, implementation and evaluation of policies in the health care facilities. Key Interdisciplinary Team Personnel Needed Provide Care to Achieve Optimal Disorder Management and Outcomes The key interdisciplinary team personnel that will be needed to ensure the provision of optimal care to the patient include GP, practice nurse, dietitian, and pharmacists. The GP personnel will contribute to the provision and achievement of optimal management and outcome by ensuring that the right amount of monthly gluten-free diet is recommended to a patient with celiac disease. Practice nurse will play a critical role in the provision of care by providing a sensible advice to the patient and refer the patient to dietitian when necessary (Dickson, Streutker and Chetty, 2006). Secondly, the practice nurse will help and support the patient with celiac disease to adhere to the gluten-free diets. Additionally, the practice nurse will aid the provision of optimal management of celiac disease by arranging for blood tests, as well as acting as the first point of contact between dietetic and medical appointments. The dietitian will also play a critical role in the provision of care ensuring that the recommended gluten-free diets are balanced, assessing a patients nutritional status, monitoring a patients body weight, as well as reviewing a patients dietary needs regularly to ensure optimal outcome. Lastly, the pharmacist will assist in the provision of optimal care and management of celiac disease by providing the right prescription for the patient (Green and Jones, 2010). The pharmacist will also contribute to the provision of care by liaising with other health care providers managing the patient, as well as provide support and advice to the patient where necessary. Barriers to Optimal Disorder Management and Outcome In order to provide effective management for patients with celiac disease like the 34-year old man, it is necessary for health care providers to understand the barriers and come up with better ways of overcoming the barriers. In most cases, barriers to disorder management emanate from the patients personal perception. Barriers to effective management of celiac disease can be divided into five categories, namely physical, economic, social-cultural and psychological. Physical barriers: patients suffering from celiac diseases sometimes develop physical disability, due to diarrhea and weight loss, which result in loss of strength, vision and sometimes the sensation (MIMS, 2006). Economic barriers: Socioeconomic status of the patient is a critical factor in determining an individuals health status. For a patient to receive optimal management for the disorder, they need to use massive resources, which the patient may not have. This is likely to act as a major impediment to celiac disorder management and outcome (MIMS, 2006). Socio-cultural barriers: The participation of the family member of a patient can either promote or impede a patient self-care response. The patient may be a strong believer of the use of traditional medicine. This might be a barrier to the provision of care to the patient. Cognitive barriers: The patients knowledge about the effects of celiac disease has a powerful influence on the patients ability to perform self-care. In this regard, if the patient in question does not understand the need for medication, then the patient will not be able to separate between the signs of the disease and the side effects of medications. In this case, the main barrier that the patient might encounter is maintaining diets free of gluten. Psychological barriers: depression and distress are among the major psychological barriers to proper management of celiac disease. Depression is the most common psychological effect of celiac disease (Green and Jones, 2010). Patients with celiac disease also tend to undergo periods of emotional distress, which acts as a barrier to realizing their behavioral objectives with regards to disease management. Strategies to Overcome the Barriers There is a variety of strategies that can be adopted by health care providers to help patients with celiac disease achieve optimal disease management and outcome. The strategies may include but not limited to motivational interview, peer support, enhancing self-efficacy, as well as assessing the patients cultural beliefs. Motivational Interviewing Motivational interview are an effective strategy for overcoming barriers to health management (MIMS, 2006). This is because it helps improve the emotions of a patient by making them feel valued and empowered to alter their behaviors to achieve optimal management and outcome. In this case, the person conductive an interview is expected to use structured questions while also listening to the patient to enhance participation from the patient. The interview may help unearth certain self-management issues, which may be critical in ensuring optimal management and outcome. Peer Support The MIMS (2006) report shows that peer support is another strategy that has proven effective in overcoming barriers to self-management of diseases, such as celiac disease. Some patients with celiac disease may find it comfortable sharing their health problems with others who are closer to them than with the health care providers. Therefore, to overcome the stated barriers, it would be critical to consider providing peer support, which may take the form of home visits, phone calls, group meetings or messaging. Peer support help overcome barriers to disease management by creating social, emotional and practical help needed for managing the disease and staying healthy. Self-Efficacy Overcoming the stated barriers would require promoting self-efficacy of the patient. This would entail encouraging the patient to take charge of his life by believing that he can manage the condition despite the existence of the challenges. Evaluating Cultural Beliefs Cultural beliefs sometimes act as a major impediment to disorder management. Therefore, to overcome barriers associated with cultural believes, it would be appropriate to assess the patients cultural belief in order to understand how best to approach the treatment. Assessing a patients cultural beliefs may be done by adopting either common-sense model or explanatory model. Care Plan Synthesis Because the intake of diets with gluten is among the major causes of celiac disease, the first step towards treating TM is to recommend to the patient the right diets to take to manage the disease. This will include recommending to the patient the minimum monthly gluten-free diets which the patient will have to consume (MIMS, 2006). Since different patients required different amounts of gluten-free diets, the health care providers must ensure that these factors are considered when designing the right gluten-free diets for the 34-year old patient. Once the right diet has been recommended, periodic follow-ups will be made to ensure that the patient adheres to the recommendations. This is because failing to adhere to the gluten-free diets may result in a relapse. The follow-up will also provide an opportunity to review or change the gluten-free diet depending on how the patient is responding to treatment. The weight will also be checked periodically to ensure that the treatment is yielding result. However, since the advanced stages of celiac disease might not be treated by recommending gluten-free diets, a thorough examination will be conducted to see if the disease has caused too much damage to the villi. In the case that this proves to be the case, the 34-year old patient will be provided with nutritional supplements to heal the intestinal linings while requiring the patient to maintain gluten-free diets for the rest of his life. However, as earlier noted, socio-cultural background is one of the major barriers to disease management. This applies to this case, where the socio-cultural background of TM will have a huge impact on the optimal management and outcome of treatment. Socio-cultural background refers to the beliefs held by the patient regarding the disease and its management method. Firstly, TMs belief about the cause and treatment method for celiac disease can potentially impact on the optimal management and outcome. This is because such beliefs restrict health care providers to proving care that is in tandem with the patients belief. For instance, in case it turns out that the patient is from Asia, then the health care provider might be restricted to allowing the patient to use complementary healing methods. This might impact on the management and outcome. Management of celiac disease requires restricting patients to gluten-free diets. Therefore, treating the 34-year old could be a big problem if his culture requires him to eat these diets during certain occasions, thereby affecting optimal management and outcome. A number of key issues are also presented in the case that needs to be addressed. From the case it is evident as the patient complains of diarrhea, abdominal bloating, and gas and weight loss. These symptoms clearly show that TM is suffering from celiac disease. Therefore, in order to manage this condition, TM will be required to adhere to gluten-free diets as the first step towards healing. In this regard, gluten-free diets will be recommended with the help of a dietician. The second issue in the case is that the patient does not exercise. Exercising is very key to any healing process (Thompson, 2006). Therefore, to ensure optimal management of the disease, TM will be required to perform exercises regularly as he adheres to the gluten-free diet. Lastly, the case shows that TM consumes at least six beers weekly. This is a major barrier to the healing process since beer is mostly made of barley, which has high gluten content. Therefore, to manage the disease, TM will be advised to stop drinking beer as a way of helping him heal from celiac disease. References Barker, J. M., & Liu, E. (2008). Celiac disease: Pathophysiology, clinical manifestations and associated autoimmune conditions. Adv Pediatr., 55, 349–365. Dickson, B. C., Streutker, C. J., & Chetty, R. (2006). Coeliac disease: an update for pathologists. Journal of Clinical Pathology, 59(10): 1008–1016. Green, P. H. R., & Jones, R. (2010). Celiac disease: A hidden epidemic. New York, NY: HarperCollins. MIMS (2006). The management of adults with coeliac disease in primary care. Retrieved from http://www.mims.co.uk/news/882147/Management-Adults-Coeliac-Disease-Primary-Care/ National Foundation for Celiac Awareness. (2014). Celiac disease: Fast facts. Retrieved from http://www.celiaccentral.org/celiac-disease/facts-and-figures/ Thompson, T. (2006). Celiac disease nutrition guide. New York, NY: American Dietetic Association. Read More