Question

• Describe the pathophysiology of celiac disease, clinical manifestations, evaluation, and treatment. What are the differences between non-celiac gluten sensitivity and celiac disease?

Answer 1

Celiac disease is an immune reaction which occurs after ingesting gluten, which is a protein found in wheat, barley or rye.

Pathophysiology- There are multiple proposed pathways involved in the pathogenesis of celiac disease that leads to enterocyte destruction and subsequent villous atrophy – all which are related to dietary gluten, the major storage protein of wheat, barley and rye.

Gliadin is a glycoprotein extract from gluten that is felt to be directly toxic to the enterocytes of individuals with celiac disease, primarily through the overexpression of IL-15 in the intestine.

In addition, gliadin peptides have been shown to upregulate both the stress molecule MIC-A on the surface of enterocytes and also the NKG2D receptor on the infiltrating intraepithelial lymphocytes, to promote a lymphocyte-mediated cytotoxic response against enterocytes that is also IL-15 dependent .

TG is important in the pathogenesis of celiac disease in that the enzyme crosslinks ingested gliadin and causes specific deamidation of glutamine into glutamic acid in gliadin peptides.

Clinical menifestation:- It includes-

* Abdominal pain

* Diarrhoea

* Failure to thrive

* Malnutrition

* Vomiting

*Itchy skin

*Headache & fatigue

* Bloating or excessive gas

* Acid reflux & heart burn

* Aneamia

Evaluation and treatment :- Patients should also be evaluated for osteoporosis, thyroid dysfunction, and deficiencies in folic acid, vitamin B12, fat-soluble vitamins, and iron, and treated appropriately.

Treatment includes-

* Motivation to the patient.

* Gluten free diet as per dietician guidance.

* Vitamin and mineral supplements.

* attentiveness of the physician to comorbidities that need to be addressed.

Difference between non- celiac gluten disease and gluten disease:-

Gluten sensitivity and gluten intolerance do not cause damage to the lining of the small intestine. The body does, however, identify gluten as a foreign invader which triggers the launch of an immune response. For example, someone who experiences mild symptoms triggered by gluten consumption that resolve quickly may be diagnosed with gluten sensitivity. On the other hand, someone who develops serious symptoms that last for a longer period of time would likely be diagnosed with gluten intolerance..