Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result ofan immune response to ingested gluten in genetically predisposed individuals. It is a genetically determined autoimmune-like disorder induced by Gluten, the storage protein of wheat and similar proteins found in barley and rye. The presence of gluten in these subjects leads to self-perpetuating mucosal damage, whereas elimination of gluten results in full mucosal recovery. The symptoms of celiac disease vary among individuals and depend on the amount of gluten a person consumes. Symptoms can affect the digestive tract as well as other parts of the body. Common symptoms include excessive gas, abdominal bloating, diarrhea, weight loss, and fatigue. Some people who have celiac disease may have no symptoms. Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is far more common than once believed. It commonly runs in families and in populations with other autoimmune diseases and genetic disorders (Source: NIDDK).
Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been under diagnosed or misdiagnosed. Due to lack of sensitivity and specificity of antibodies to gliadin component of gluten, it is not now used for diagnostic purposes2. Whereas, the endomysial antibody (EMA) has a good specificity for celiac disease and has become the "gold standard "serological test. There was the study which provides substantial evidence for a very strong genetic component in coeliac disease, which is only partially due to the HLA region.
In monozygotic twins the likelihood of having celiac disease increases to 75% and 10% to 20% in persons who have a first-degree relative with the disease4,5. Further, patients who have Turner's syndrome, Down syndrome, type 1 diabetes mellitus, or other disorders are at increased risk for developing celiac disease. In recent years population studies have revealed a much higher prevalence, particularly in individuals of European ancestry. Celiac disease also occurs in people who are not of European descent, although the prevalence is not as great. People from India like those of regions Punjab and Gujarat who lived in England, they developed celiac disease 2.7 times as often as Europeans on a gluten-rich diet; further during the summer months, when wheat commonly replaces maize in the diet a disorder termed summer diarrhea has long plagued people of the tropics. The prevalence of celiac disease is rising. As a result there is increasing interest in the associated mortality and morbidity of the disease. Screening of asymptomatic individuals in the general population is not currently recommended; instead, a strategy of case finding is the preferred approach, taking into account the myriad modes of presentation of celiac disease. Although a gluten-free diet is the treatment of choice in symptomatic patients with celiac disease, there is no consensus on whether institution of a gluten-free diet will improve the quality of life in asymptomatic screen-detected Celiac disease patients. A review of the studies that have been performed on this subject is presented. Certain patient groups such as those with autoimmune diseases may be offered screening in the context of an informed discussion regarding the potential benefits, with the caveat that the data on this issue are sparse. Active case finding seems to be the most prudent option in most clinical situations.
Table 1: Risk Factors for Celiac Disease
Risk factor | Prevalence of celiac disease among those with risk factor (%)
First-degree relative with celiac disease | 5 to 22
Dermatitis herpetiformis | 100
Autoimmune thyroid disease | 1.5 to 14
Turner's syndrome | 2 to 10
Down syndrome | 5 to 12
Type 1 diabetes mellitus
Children | 3 to 8
Adults | 2 to 5
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The author is pursuing M.Phil/PhD in Environment and sustainable development from Central University of Gujrat.
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