• Celiac Disease Overview:
  • A chronic enteropathy of the small intestine caused by gluten exposure in genetically susceptible individuals.
  • Requires permanent gluten exclusion from the diet.
  • Symptoms include diarrhea and failure to thrive, though some individuals may be asymptomatic.

<aside> 👉 When a celiac person ingests gluten, his or her immune system will attack against its own body's tissue. Whereas, if a person is Non-celiac gluten sensitivity (NCGS), the consumption of gluten will cause short-term bloating and belly pain. Unlike celiac disease, gluten intolerance doesn't usually cause long-term harm to the body

</aside>

• Classification and Explanation:

  • Etiology:
    • Damage to enterocytes in the small intestine leads to symptoms.
    • Involves chronic inflammation and villi atrophy.
    • Requires presence of HLA DQ2 or DQ8 genes.
    • An immune reaction to gluten, with tissue transglutaminase antibodies playing a role.
    • Gliadin in gluten has a direct toxic effect on enterocytes via IL-15 production.
    • Early childhood gastrointestinal infections may contribute to development.
  • Diagnosis:
    • Involves detecting IgA antibodies to endomysium and tissue transglutaminase.
    • 5% of patients may have immunoglobulin deficiencies.
  • Pathophysiology:
    • Characterized by chronic inflammation and intestinal villi atrophy.
    • Gluten induces damaging immune responses in the small intestine.
  • Genetic Factors:
    • Genetic predisposition with HLA DQ2 or DQ8 genes is necessary.
  • Immune Response:
    • Involves antibodies to tissue transglutaminase.
    • Other pathways also play a role.
  • Toxic Effects:
    • Gliadin triggers IL-15 production, causing direct enterocyte toxicity.
  • Infections:
    • Early childhood gastrointestinal infections may influence disease onset.
  • Clinical Presentation:
    • Symptoms include diarrhea and failure to thrive.
    • Some individuals may be asymptomatic

  <aside> 👉 Celiac disease is not an allergy or food intolerance – people with the condition do not go into anaphylactic shock if they eat gluten-containing food. Instead, celiac disease is an autoimmune disease – the body's immune system attacks healthy cells, causing a reaction that is sometimes severe and immediate.

  </aside>

• Additional Insights on Celiac Disease:

  • Late or atypical presentation may be linked to cereal introduction timing or breastfeeding.
  • Extraintestinal symptoms include vitamin D deficiency, psychiatric issues, arthritis, osteoporosis, anemia, ataxia, headaches, infertility, and myocarditis.
  • Latent form: positive serology, negative biopsy.
  • Silent form: no symptoms, positive serology, and biopsy.
  • IgA antigliadin is less sensitive/specific than IgA anti-TTG and anti-endomysial.
  • HLA DQ2 and 8 are highly sensitive but not specific; used for ruling out disease.
  • 1-2% have IgA deficiency but may still show symptoms; IgG can aid diagnosis.
  • Complications include intestinal lymphoma, anemia, osteoporosis, infertility; nutritional deficiencies should be tested.
  • Dexa scans and pneumococcal vaccinations are recommended due to hyposplenism.
  • Non-responsiveness may indicate other conditions like intolerance or IBS.