World Digestive Health Day WDHD – May 29, 2016 CELIAC DISEASE CAROLINA CIACCI, MD University of Salerno Salerno, Italy PETER GREEN, MD Columbia University New York, New York, USA JULIO C. BAI, MD Del Salvador University Buenos Aires, Argentina DEFINITIONS Celiac disease (CD) is a chronic enteropathy produced in genetically predisposed subjects by the ingestion of gluten. Gluten represents the protein mass that remains when wheat dough is washed to remove starch. Gliadins and glutenins are the major protein components of gluten and are present in wheat, rye, and barley. Non-celiac gluten sensitivity is a condition in which people in whom CD and wheat allergy has been excluded present symptoms which improve with a gluten free diet (GFD). Wheat allergy is an adverse immunologic reaction to wheat proteins, mostly IgE- but rarely also non-IgE mediated. It may present as an allergy affecting the skin, gastrointestinal or respiratory tract, a contact urticarial, but also as the so called exercise-induced anaphylaxis, or as asthma/rhinitis (baker’s asthma). EPIDEMIOLOGY CD is common, with a world prevalence of about 1%, varying from 0.14%-5.7%. The observed increased number of new cases in the last decades is due to better diagnostic tools and thorough screening of individuals considered to be at highrisk for the disorder. However, the ratio of diagnosed to undiagnosed cases of CD varies from country to country, suggesting that most cases of CD are still undetected. Globally, there is the need to increase the knowledge of disease, especially among primary care doctors. ROLE OF GENETICS The MHC-HLA locus is the most important genetic factor in the development of CD. The disorder is associated with human leukocyte antigen (HLA)-DQA1 and HLA-DQB1 genes, and the alleles HLA DQ2 (95%) and DQ8 (the rest) are present in the vast majority of CD patients. Recent data showed that also HLA class-I molecules are associated to the disorder. SYMPTOMS CD may present at any time in life with an ample spectrum of symptoms and signs. Classical CD presents with signs and symptoms of malabsorption, including diarrhea, steatorrhea, and weight loss or growth failure in children. In the so called non-classical form of CD, patients may present with mild gastrointestinal symptoms without clear signs of malabsorption or with extra-intestinal manifestations. In this case the patient will suffer from abdominal distension and pain and a myriad of extraintestinal manifestations such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy unexplained chronic hypertransaminasemia, reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis, etc. The family screening that follows a CD diagnosis has shown that CD may run asymptomatic, in asymptomatic CD patients, however, the GFD will also improve the quality of life and health. DIAGNOSIS The gold standard for CD diagnosis relies on the presence in serum of CD specific serology and the intestinal biopsy shows the presence of increased number of intra-epithelial lymphocytes (IELS) and various degrees of villous shortening. World Digestive Health Day WDHD May 29, 2016 WGO Handbook on DIET AND THE GUT 29
WGO Handbook on Diet and the Gut_2016_Final
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