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CELIAC DISEASE. WHAT WE WILL COVER. Development of the disease Types of Celiac disease Associated Conditions Symptoms Why is it so hard to diagnose Gluten-free diet Resources for you and your patients. Celiac Isn’t…. a food allergy. Celiac Is…. Curable.

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CELIAC DISEASE


What we will cover
WHAT WE WILL COVER

  • Development of the disease

  • Types of Celiac disease

  • Associated Conditions

  • Symptoms

  • Why is it so hard to diagnose

  • Gluten-free diet

  • Resources for you and your patients


Celiac isn t
Celiac Isn’t…

a food allergy

Celiac Is….

Curable

An autoimmune disorder that is characterized

by consuming a protein called gluten

Treatable


Fast facts
FAST FACTS

  • 1. One in 133 Americans have celiac disease.

  • 2. Three million Americans across all races, ages and genders suffer from celiac disease.


Fast facts1
FAST FACTS

3. 17% of celiac patients have an immediate family

member who also has celiac.

6. $5,000-$12,000 is the average cost of misdiagnosis per person

per year, not including lost work time.


Details about celiac disease
Details about Celiac Disease

Sometimes called:

  • Celiac sprue

  • Non-tropical sprue

  • Gluten sensitivity

  • Gluten enteropathy


Celiac disease
Celiac Disease

  • Autoimmune disorder

  • Often triggered by a stressful event

  • Damages the villi of the small intestine

  • Interferes with the absorption of nutrients


Risk factors
Risk Factors

  • It is a genetic disorder

  • 17% of celiac patients have an immediate family member with celiac disease

  • Was thought to be a disease of infants but now often presents between the ages of 10 and 40


How do we test for celiac
How do we test for Celiac?

  • Serology

    • IgA anti tissue transglutaminase antibody (IgA tTg)

    • IgA endomysial antibody (IgA EMA)

    • IgA antigliadin antibody (IgA AGA)

    • IgG antigliadin antibody (IgG AGA)


Application of serology tests
Application of Serology Tests

  • Individuals with low pretest probability

  • Individuals with moderate or high probability

  • Monitoring adherence and response to gluten-free diet


Other serology tests
Other Serology Tests

  • Genetic testing

    • HLA DQ2

    • DQ8

    • Those without these genetic markers are very unlikely to have celiac disease


Other serology tests1
Other Serology Tests

  • Testing for malabsorption problems

    • Iron Deficiency Anemia

    • Folic Acid Deficiency

    • Vitamin D Deficiency


Problems with serology testing
Problems with Serology testing

  • Not 100% accurate

  • Can be falsely negative if patient has started a gluten-free diet


Pathology
Pathology

  • Small Bowel Biopsy

    • Multiple biopsies from second and third portion of duodenum


Problems with pathology
Problems with Pathology

  • May not be accurate if patient has started a gluten-free diet

  • Other causes for Villious atrophy


Types of celiac disease
Types of Celiac Disease

  • Classical Form

    • Villous Atrophy

    • Symptoms of malabsorption

      • Steatorrhea

      • Weight loss

      • Signs of vitamin and nutrient deficiencies

    • Resolution of mucosal lesions and symptoms when on gluten-free diet


Types of celiac disease1
Types of Celiac Disease

  • Classic Form

  • Latent Form

    • Positive serology but negative pathology

    • No or minor symptoms while on normal diet

    • Normal mucosa at one time but Celiac developed later


Types of celiac disease2
Types of Celiac Disease

  • Classic Form

  • Latent Form

    • Positive serology but negative pathology

    • No or minor symptoms while on normal diet

    • Normal mucosa at one time but Celiac developed later

  • Potential Celiac Disease

    • Negative pathology but positive serology including genetic predisposition and 1st degree relative


Types of celiac disease3
Types of Celiac Disease

  • Classic Form

  • Latent Form

    • Positive serology but negative pathology

    • No or minor symptoms while on normal diet

    • Normal mucosa at one time but Celiac developed later

  • Potential Celiac Disease

    • Negative pathology but positive serology including genetic predisposition and 1st degree relative

  • Subclinical Disease

    • Very mild form and goes widely undetected

      • Malignancy, nutritional deficiencies, low birth-weight infants, occurrence of autoimmune disorders


Associated conditions
Associated Conditions

  • Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers and other autoimmune diseases.

  • Frequently associated with Dermatitis Herpetiformis, Down Syndrome, Type 1 Diabetes, Thyroid Disease, Liver Disease, and Atopic Dermatitis



Bloating

Gas

Diarrhea

Abdominal Pain

Constipation

Weight Loss



Headaches

Irritability

Depression

Tingling/Numbness


Growth

Thin Bones

Joint Pain

Dental


Pale Mouth Sores

Fatigue

Itchy Skin Rash



Why is this hard to diagnose1
Why is this hard to Diagnose?

  • 97% of celiacs are undiagnosed or misdiagnosed with other conditions.

  • 10 years is the average time a person waits to be correctly diagnosed.

  • $5,000-$12,000 is the average cost of misdiagnosis per person per year, not including lost work time.


Increase awareness
Increase Awareness

  • 500,000 new celiac diagnoses are expected to occur in the next 5 years thanks to efforts to raise public awareness of celiac disease.


Treatment
Treatment

  • There are NO pharmaceutical cures for celiac disease.

  • A 100% gluten-free diet is the only existing treatment for celiac disease.


What is gluten
What is Gluten?

  • The group of proteins found in wheat, rye, and barley

  • It’s found in obvious foods like bread, pasta, and cereals

  • Also found in many “hidden” foods



Breads grains cereals
Breads, Grains, Cereals

  • Rice

  • Corn

  • Potato

  • Tapioca

  • Soy

  • Millet

  • Beans


Vegetables and fruits
Vegetables and Fruits

  • Naturally gluten free

  • May add pure spices but be careful of spice blends as they often use gluten as a filler


Milk and dairy
Milk and Dairy

  • May need to avoid Lactose until intestines heal

  • Gluten-free, Dairy-free alternatives

    • Rice, soy, hemp, or nut (almond, hazelnut)

  • Gluten-free lactase enzyme supplement


Meats and other proteins
Meats and other Proteins

  • Beef, Chicken, Pork, and Fish are naturally gluten-free unless they have been seasoned or basted (turkey, deli meat, etc.)


Fats oils and sweets
Fats, Oils, and Sweets

  • Olive and Canola oils

  • Nuts and Pure nut butters

  • Avoid candies not marked gluten free


Gluten free products
Gluten-free Products

  • The gluten-free marketplace is growing by 28% each year

  • Find Gluten-free products in specialty health food stores

  • Now available in many grocery stores including Meijer, Kroger, Walmart, etc

  • Also available on-line


  • C

  • E

  • L

  • I

  • A

  • C

onsultation with skilled dietitian

ducation about the disease

ifelong adherence to gluten-free diet

dentify & treat nutritional deficiencies

ccess to an advocacy group

ontinuous long-term follow-up


Resources
Resources

  • Physician/Endoscopy office

  • Web

    • www.celiac.org

    • www.gluten.net

    • www.csaceliacs.org

    • www.americanceliac.org

    • www.celiacawareness.org

    • http://celiacdisease.about.com/forum


Resources1
Resources

  • Friends

  • Library…Cookbooks, etc


Personal passion
Personal Passion

  • I first heard gluten enteropathy when I was about 9 years old

  • Limited products

  • Associated conditions

  • I now live with Celiac Disease


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