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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

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Celiac disease

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


G i symptoms

G I Symptoms


Celiac disease

Bloating

Gas

Diarrhea

Abdominal Pain

Constipation

Weight Loss


Non g i symptoms

Non-G I Symptoms


Celiac disease

Headaches

Irritability

Depression

Tingling/Numbness


Celiac disease

  • Infertility

Growth

Thin Bones

Joint Pain

Dental


Celiac disease

Pale Mouth Sores

Fatigue

Itchy Skin Rash


Why is this hard to diagnose

Why is this hard to Diagnose?


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


What is safe to eat

What is Safe to Eat?


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


Celiac disease

  • 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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