Celiac disease is considered one of the most common food intolerance conditions all over the world. The condition is genetically related and is an autoimmune disorder that is common among people who are genetically susceptible. It is most commonly triggered by environmental factors such as gluten and prolamins which are present in barley, rye, and wheat (Kelly, et al., 2015). This condition mostly damages a person’s small intestine and with time it fattens the mucosa. The patients who suffer from this disease are classified as those that have latent, potential or silent celiac disease.
In the silent category, the patients have the disease as defined above but show no symptoms. The disease at this stage is identified through screening asymptomatic persons who are considered to be at risk of getting the disease. In the potential stage, the individuals have the particular serum auto-antibodies and could have or lack the symptoms of the disease. The patients would not have any evidence showing the presence of autoimmune damage to the mucosa (Kelly, et al., 2015). The latent stage is the final and serious stage of the disease whereby the individuals have the same mucosal morphology as the potential stage but are known to have been exposed to gluten for a period of time. The disease is more common in the old age but could occur at any stage of a person’s life.
In celiac disease, the auto-antigen known as the transglutaminase is targeted for the abnormal immune response. Gluten remains the common environmental factor that triggers the condition in most cases. The celiac disease is closely associated with the haplotypes of HLA DQ2 class II; it also has some association with the halophyte DR-4 DQ8.More research has been carried out leading to increased understanding of the pathogenesis of the condition. The medical professionals have increased their understanding of the adaptive and innate immunity.
In the innate immunity, the important role played by the intraepithelial lymphocytes (IELs) in the obliteration of the epithelial cell has been understood (Rubio–Tapia, et al., 2013). The IELs identify the nonclassical core histocompatibility complex in the individual’s system which has been brought to the surface through inflammation and stress. When the histocompatibility complex molecule (MHC)-I is introduced into the enterocytes’ surface, the IELs are activated and turned into lymphokine-activated killing cells. These activated cells kill the epithelial cells present in the T-cell receptor.
In adaptive immunity, there are specific peptide sequences that respond to gluten. The binding of these sequences occurs through binding to HLA-DQ8 or DQ2 molecules and the resulting activation of gluten-specific CD4 T cells (Kelly, et al., 2015). The indigestibility of gluten is mainly because of its complexity and the abundant content of glutamine and proline residues present in the macromolecule.
The disease is common all over the world and the technological advancements have made it easy to test for the presence of the disease in individuals. The Saharawi children remain the most affected groups by the celiac disease (Leffler, Green & Fasano, 2015). The prevalence of celiac disease is drastically increasing, especially in the recent past. The epidemiology data shows that the disease prevalence doubles after every two decades.
One of the explanations for the rapid increase is the increase of issues related to the environmental factors. Some of the explanations given for the drastic increase include the hygiene hypothesis, increased cases of caesarean delivery and changes in children feeding practices. Early vaccination has been ruled out as a risk factor in the spread of the disease according to the recent studies carried out in Sweden
Indications of the Disease
Celiac disease has various symptoms which are different among children. In adults, the most common symptoms include iron deficiency, depression, arthritis, joint pain, seizure, numbness of the feet, sores in the mouth among other symptoms (Leffler, Green & Fasano, 2015). Among children, the common symptoms include stunted growth, constipation, loss of weight, persistent diarrhea which may be stained with blood at times, fatigue, vomiting, failure to prosper among others. Malnourishment is another common problem among the people suffering from celiac disease.
The stomach may protrude and the thighs become thin with buttocks becoming flat. Among the teens, the symptoms may not be visible until it becomes more serious or when they are faced with more stressful situations. These situations may include when they leave their homes or when they are injured (Rubio–Tapia, et al., 2013). It may also show up during pregnancy or when one is sick. One the symptoms are visible, they are more the same as those found among the young children such as chronic diarrhea, feeling of being tired all the time, sharp abdominal pain and weight loss. It is also normal to find the teens with this condition having late puberty, depression, issues with their growth and sores in their mouth.
Treating celiac disease requires that the individual stops intake of gluten-containing food from their diet. Avoiding the intake would help in preventing the damage caused to the linings of the intestines and the related problems such as sharp pain in the stomach and diarrhea (Leffler, Green & Fasano, 2015). A person with the celiac disease condition would have to stop intake of any source of gluten forever. Going back to the consumption of foods that contain gluten would lead to long-term damage to the person’s health. It is that expected that the symptoms of the disease would stop after a few weeks of the gluten-free diet.
Upon the first diagnosis, the patient would be directed to a dietician who would help them adjust to their gluten-free diet as directed by the doctors. The dietician would also ensure that the diet taken is well balanced and has all the required nutrients. Even a small consumption of gluten would lead to unpleasant feeling and symptoms in the intestine (Rubio–Tapia, et al., 2013). Continuous consumption of gluten would expose the patient to the high risk of contracting cancer and osteoporosis later in their life. Gluten is not considered an essential nutrient hence other foods could be used to replace it. It is possible to find gluten-free foods in the leading supermarkets and other stores that deal with healthy foods.
Most of the basic meals such as potatoes, vegetables, rice, meat, and cheese are all free from gluten hence their inclusion in the diet are recommended. The dietician would help the patients to come up with safe foods to eat and which one should be avoided (Leffler, Green & Fasano, 2015). The gluten-free foods include dairy products such milk and butter; vegetables and fruits; fish and meat; potatoes; noodles and rice; potato, corn, soy and other gluten free flours.
The foods that contain gluten include bread, cereals, biscuits, sauces, gravies and pasta among other foods. The law requires that foods that contain gluten be labeled as well as those that do not contain gluten (Kelly, et al., 2015). The labeling is intended to inform the genetically susceptible individuals. Caution should be taken to ensure that these kinds of foods are not prepared together.
Kelly, C. P., Bai, J. C., Liu, E., & Leffler, D. A. (2015). Advances in diagnosis and management of celiac disease. Gastroenterology, 148(6), 1175-1186.
Leffler, D. A., Green, P. H., & Fasano, A. (2015). Extra intestinal manifestations of coeliac disease. Nature Reviews Gastroenterology & Hepatology, 12(10), 561-571.
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: diagnosis and management of celiac disease. The American journal of gastroenterology, 108(5), 656-676.