Celiac’s Disease

1. Celiac’s Disease • Chloe Bierbower • Kelly Lonergon • Brittany Pinkos • Sarah Steinmetz 1

2. What is Celiac’s disease? • An autoimmune enteropathy triggered by the ingestion of gluten-containing grains in susceptible individuals resulting in intestinal damage • Disease of both malabsorption and abnormal immune reaction to the protein gluten • Main groups of proteins • Gliadins, glutenins and other alcohol-soluble proteins found in grains • Also known as celiac sprue, nontropical sprue and gluten- sensitivity enteropathy

3. What is Gluten • Composite formed from several different proteins • Found most commonly in wheat and other related grains • Used in many processed foods as a thickener, binder, flavor enhancer and protein supplement

4. The Autoimmune response • CD is the result of inappropriate T cell-mediation • Glutenin and gliadin (GLU) derived peptides in native or de-amidated form act as antigens • Activates lamina propria to infiltrate CD4+ T lymphocytes isolated from intestinal mucosa from small intestine • Leads to the release of proinflammatory cytokines (in particular y-interferon) which cause profound tissue remodeling

5. The Autoimmune Response • Specific CD4+ T-cell responses to GLU peptides are due to genes HLA-DQ2 and HLA-DQ8 • Possible to have 2 HLA-DQ2 genes, 2 HLA-DQ8 genes or one of each • 2 HLA-DQ2 genes results in the highest susceptibility for CD • The occurrence of either of these genes does not mean a patient will develop CD

6. CLinical research study • Study found that both adult and young patients with CD, regardless of which genes expressed, can respond to a diverse repertoire of GLU peptides • Still don’t know if a specific GLU protein triggers a specific immunologic response • responsehttp://glutenintolerance.net/Celiac-Gluten-Gliadin-Peptides-Multiple-Vader.pdf

7. Consequences of the autoimmune response • Immune reaction attacks and destroys small intestinal villi • Small intestinal villi aids in the absorption of nutrients • Without healthy villi the intestine cannot extract and absorb nutrients from food no matter the quantity of food consumed

8. Causes? • Unclear as of now • It is genetic • Sometimes triggered or becomes active after surgery, pregnancy, childbirth, viral infection or severe emotion stress • Some gene mutation increase risk • More common in people with type 1 diabetes, autoimmune thyroid disease, down syndrome, and microscopic colitis

9. What are the symptoms of CD? • Symptoms subdivided in typical or atypical forms • Vary with the age of the patient, duration and extent of disease and the presence of extraintestinal pathology • Can be completely asymptomatic

10. SYmptoms of CD • Typical form (Typically in infants 6-18 months of age) • chronic diarrhea • failure to thrive • abdominal distention • anorexia • muscle waisting

11. Symptoms of cd • Atypical form (more common in older children and adults) • dermatitis herpetiformis • iron-deficiency anemia • short stature • dentil enamel hypoplasia • arthritis and arthralgia • chronic hepatitis and hypertransaminaemia • osteoporosis • neurologic problems • other GI problems 11

12. Adults are less likely to witness normal symptoms but may experience instead…. • Fatigue • bone or joint pain • Arthritis • Bone loss/ osteoporosis • depression or anxiety • Tingling or numbness in hands and feet • seizures • Missed menstrual periods • Infertility or recurrent miscarriages • Canker sores inside the mouth • Itchy skin rash called dermatitis herpetiformis

13. Why are symptoms varied? • Currently being studied • Could depend on length of time the person was breastfed • Age the person starting consuming gluten • Amount of gluten containing foods a person eats • Condition of the persons small intestine

14. A number of medical conditions are significantly associated with cd • Type 1 diabetes • Autoimmune atrophic gastritis • Autoimmune emocytopenic diseases • Autoimmune thyroid disease • Autoimmune liver disease • Rheumatoid arthritis • Addison’s disease • Sjogren’s syndrome • 2-5% of patients with CD develop refractory CD, a serious complication associated with 50% risk of lymphoma development

15. Epidemiology of cd • Originally thought to be a rare childhood disease • Can be diagnosed at any age because CD may develop later in life • Over 2 million Americans have CD • Affects approximately 1 in every 133 Americans, similar European statistic • Global prevalence of CD is increasing

16. How is Celiac disease diagnosed? • Difficult to diagnose • Often mistaken for other diseases • IBS, Diverticulitis, intestinal infections • Histological and serological testing are essential • look for abnormalities in small intestine and presence of certain IgA autoantibodies • Positive diagnosis made when: • 1. typical small-intestinal histopathological abnormalities defined as hyperplastic villous atrophy • 2. clinical remission on a strict gluten-free diet with relief of symptoms within weeks

17. How is it treated? • Only known treatment is a Gluten- Free Diet • Complications • Common for food presumed to be “gluten free” is contaminated • Expensive • Some medications and vitamins contain gluten • Supportive nutritional care with emphasis on iron and calcium

18. The Gluten free diet • Includes not eating foods that contain wheat, barley or rye and certain soy products • Products made from these include cereals, pasta, and many processed foods • Important to talk to chefs, waiters and pharmacists

19. Foods To avoid • Foods containing wheat, barely, or rye • Bulgar (several different wheat species) • Durum (species of wheat) • Farina (cereal food, cream of wheat) • Graham flour (whole wheat flour) • Semolina (purified wheat from durum wheat) • Spelt (ancient wheat species) • Triticale (wheat-rye hybrid) • Foods that contain these unless specified “gluten free”

20. overall most common physical Complications of cd • Malnutrition • Iron deficiency anemia • Loss of calcium and bone density • Lactose intolerance

21. psycho/social effects of CD • -Methods: 130 members ages 19-78 of Celiac UK write narratives on living with celiac disease in response to “Please give a written account of your experience of living with coeliac disease” • -Results: 5 categories • 1) Living with widespread ignorance • -can be undiagnosed for many years • -public ignorance • -self-education often a coping strategy • 2)Social invisibility • -limited processed foods are gluten-free • -helped by clear labeling • -since eating is often a social activity, and very often CD is overlooked • 3)Creating a coeliac community • -support from family and friends • -feel different from the community around them • 4)A changed identity • -people’s reactions to when they don’t eat certain foods • -worries of dietary self-management • -social anxiety in terms of violating appropriate rules of politeness • 5) Grief – and accepting the trade-off • -grief- response to diet restriction • -easier to make change to gluten-free diet if previously cooked • -trade-off- health can be restored • http://onlinelibrary.wiley.com/doi/10.1111/jhn.12062/full

22. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ • http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease-topic-overview • http://www.sciencedirect.com/science/article/pii/S0165247805000702