Celiac Disease(CD) is one of the most common autoimmune diseases characterized by a specific serological and histological profile and is triggered by gluten ingestion in genetically predisposed individuals.
Celiac disease is also called Gluten Enteropathy or Wheat Allergy. Gluten is the alcohol-soluble proteins found in different cereals such as wheat, rye, barley, spelt, and Kamut. There have recently significant changes in the diagnosis, pathogenesis, and natural history. CD increase in the number of diagnoses even in geriatric patients is attributed to greater availability of sensitive & specific screening tests. Prevalence of CD in India is around 0.5-1.5%.
It has got a strong genetic predisposition among HLA-DQ2 and DQ8 positive patients. Prevalence of CD is higher in first-degree CD relatives (10–15%) and in the people with Down syndrome, type1 diabetes, or IgA deficiency.
The pathophysiology includes the interplay of genetic factors and immune response to environmental antigen gluten. Gluten is deaminated by a t-transglutaminase enzyme in the body. The immune response can be mediated by t-cells and B-cells also. The clinical features of celiac diseases can be intestinal and extra-intestinal symptoms. Intestinal symptoms include recurrent or chronic diarrhoea, bloating, nausea, vomiting, constipation, failure to thrive or weight loss.
Extra-intestinal symptoms include dermatitis herpetiformis, dental enamel hypoplasia, osteopenia, osteoporosis, short stature, delayed puberty, iron deficiency anaemia resistant to iron therapy, Chronic Liver disease, arthritis, neurological diseases like ataxia, psychiatric disorders and women infertility. Diagnosis of celiac disease is by serology and further confirmed by duodenal biopsy. The serological tests for diagnosis of the CD are by IgG/IgA antibodies against Tissue Transglutaminase (TTG), Endomysial Antigen (EMA), Deaminated Gliadin Peptide(DGP) and Anti-Gliadin Antibodies(AGA).
The diagnosis is confirmed by duodenal biopsy. The duodenal biopsy is evaluated as per the marsh classification which evaluates the raised intra-epithelial lymphocytes (IEL), crypt hyperplasia and villus atrophy. Treatment of the celiac disease is by a gluten-free diet. A gluten-free diet means to avoid wheat, barley, rye and oats. Hidden gluten is also present in chocolates and ice-creams. Mostly rice and corn-based diet are safe to be consumed. Other diet products which are safe are meat, fish, fruits, vegetables, potatoes, lentils as well as milk products and juices. Celiac disease patients are monitored by resolution of symptoms and also by serological tests and normalization of duodenal biopsy. Complications of celiac disease include hyposplenism, intestinal lymphoma, small bowel adenocarcinoma and ulcerative jejunitis. In future, there are some drugs like Larazotide acetate, ALV003 and IL-15 monoclonal antibodies being evaluated for the `treatment of CD. Interestingly, there is vaccine candidate Nexvax2 also undergoing trials for treatment.
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