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Celiac disease

Gluten - sensitive enteropathy

The condition is characterized by abnormal jejunal mucosa that improves morphologically when treated with gluten free diet. Gluten is a protein that can be found in cereals, wheat, barley and oats. It is rare in Africans and Asians and affects mainly in Northern Europe.

Gluten is a high molecular weight compound that contains alpha-Gliadin which is injurious to the small intestine. An immune reaction occurs against alpha-Gliadin leading to the intestinal injury.

The mucosa of the proximal small bowel is predominantly affected with damage decreasing in severity towards the ileum as the gluten is digested into smaller non-toxic fragments.

Clinical picture (symptoms and signs)

The disease may present at any age., but peaks in adults at 20-40 years and may occur in infancy after weaning.

Symptoms are those of small bowel disease with malabsorption. There is diarrhea or steatorrhea, abdominal pain, weight loss and nutritional deficiencies. There may be evidence of anemia and malnutrition.

There is an increased incidence of autoimmune disease including thyroid disease and insulin dependent diabetes as well as inflammatory bowel disease, chronic liver disease and fibrosing alveolitis.

Diagnosis

See malabsorption

Jujenal biopsy may reveal subtotal villous atrophy. Endomysial antibodies (IgA) is the investigation of choice since it has more sensitivity and specificity than the anti-Gliadin antibodies (IgA, IgG).  IgA and IgG anti-Gliadin antibodies may be associated with false negative and false positive results. False-positives are possible as other gastrointestinal disorders are known to induce circulating antigliadin antibody, mainly Crohn disease, food protein intolerance, and postinfection malabsorption.

Treatment

A gluten free diet usually produces rapid clinical and morphological improvement. Replacement therapy (dietary deficiency) may be required. Corticosteroids and immunosuppression with cyclosporin for cases showing resistance to gluten free diet.

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