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Celiac disease affects the small intestines. When one has a celiac disease there is allergic reaction in the small intestines towards gluten that is commonly found in wheat, barley and oats. This immunological reaction results in an inflammation that destroys the inner lining of the small intestines (Fasano & Troncone, 2008). This eventually reduces the absorption of important nutrients into the body leading to symptoms of mineral and vitamin deficiencies. Celiac disease is also referred to as non-tropical sprue or gluten enteropathy
Celiac disease is mostly common in European countries such as Sweden, Italy and Ireland. United States has also indicated a high prevalence rate in Celiac disease though the symptoms of this disease are only visible in the late stages of life.
The allergic reaction towards gluten in the small intestines causes inflammation that completely destroys the small intestines. Evidence has shown that this reaction is partially inherited and genetic. This implies that around 11% of first degree relatives of persons with celiac disease have high chances of getting the disease (Fasano & Troncone, 2008). Similarly, around 35% of fraternal twins, and 65% of identical twins have high chances of both the twins having the disease. There are also some specific genes that are only available with individuals with celiac disease
Gluten is a type of protein that is present in wheat and comprises of some proteins called gliadin that dissolves in alcohol. The immunological reaction common in celiac disease is caused by the gliadin. Upon the reaction, gliadin becomes toxic and destroys the inner lining of the small intestines. Proteins such as gliadin are formed by long chains of amino acids that are attached to each other. The digestive enzymes present in the small intestines break proteins into smaller chains of amino acids for facilitation of easier absorption (Thompson, 2006).
The allergic reaction in the small intestines could be because gliadin is not completely broken down by the intestinal enzymes causing some long chains of amino acids to remain unbroken. These chains penetrate the cells at the inner intestines and hence causing the damage to the intestinal cells. One of the longer chains of the amino acids attaches to the tissue transglutaminase. In persons with celiac disease, this combination causes an immune reaction that destroys the intestinal cells. Foods that contain gliadin-like proteins such as barley and rye end up causing celiac disease in persons who are genetically predisposed (Thompson, 2006). Oats contain gliadin that cause weak inflammation and only attacks few individuals who are predisposed to get celiac disease. Corn and rice do not cause celiac disease because they lack gliadin-like proteins.
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Effects in the Small Intestine
The inner lining of small intestines has finger-like projections known as villi. They increase the surface area for absorption of nutrients into the blood stream (Blummer, 2010). The presence of celiac disease destroys the villi through inflammation making the inner lining of the small intestine to be flattened. When the villi are destroyed, it leads to mal-absorption of nutrients that eventually leads to nutrients’ deficiencies, a condition called malnutrition.
The extent of the damage at the small intestines varies from patient to patient and determines the magnitude of the signs and symptoms of the celiac disease. If all the small are affected by the inflammation, then the patient is bound to have rigorous symptoms of mal-absorption.
Signs and Symptoms
The symptoms for celiac disease range from mild to more advanced signs (Fasano & Troncone, 2008). There generally two sets of signs and symptoms namely; symptoms due to mal-absorption and symptoms due to mal-nutrition of vitamins and minerals.
Signs and Symptoms of Mal-absorption
Celiac disease reduces the absorption of crucial nutrients such as carbohydrates, fats and proteins. Absorption of fat is affected more than the other nutrients and hence most of the gastrointestinal symptoms of celiac disease are caused by the inadequate absorption of fat or fat mal-absorption. Some of these symptoms include diarrhea, flatulence, abdominal bloating and high amounts of aft in the stool (steatorrhea) (Blummer, 2010). Diarrhea occurs when the unabsorbed fats are broken down into fatty acids by the intestinal bacteria. The fatty acids enhance the secretion of water into the intestine and hence resulting into diarrhea. The fatty stools are voluminous and have foul smell, are greasy and light grey in color and have tendencies of floating in the toilet bowl. Sometimes oil droplets from undigested fats may be spotted floating on water.
Mal-absorption of carbohydrates and especially sugar lactose that is common in milk is experienced by patients suffering from celiac disease. Lactose consists of glucose and galactose and has to split into these sugars for it to be absorbed in the body (Thompson, 2006). Lactase, which is the enzyme responsible for splitting glucose and galactose, is situated on the surface of the small intestinal villi. The damage of the intestinal wall due to inflammation causes mal-absorption of lactose in patients suffering from celiac disease. Symptoms of lactose mal-absorption include diarrhea, flatulence (passing of gas), pain in the abdomen and bloating. These symptoms are as a result of the unabsorped lactose passing into the colon where it is split into galactose and glucose by the bacteria present in the colon. Gases released by the bacteria are hydrogen and methane and are responsible for the flatulence. Increased gas in the stool also cause the floating of the stool in the toilet bowl.
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Signs and Symptoms of Mal-nutrition
Some of the symptoms for nutrient deficiency include; loss of weight, fluid retention, anemia, bruising easily, peripheral neuropathy or nerve damage, osteoporosis, infertility and general muscle weakness. Weight loss is caused by the mal-absorption of fats, proteins and carbohydrates. Celiac disease causes increased appetite in the patients and therefore weight loss does not always occur. Protein is responsible of preventing fluid from leaking out of blood vessels and hence the reduction in protein levels causes fluid to leak into many tissues (edema) such as ankles and feet causing swelling of the same (Thompson, 2006). Easy bruising is caused by mal-absorption of vitamin K leading to lack of blood clotting. Nerve damage is caused is caused by the deficiency of thiamine and vitamins B12, and may lead to poor balance, muscle weakness and numbness. Infertility normally occurs in women when the celiac disease is untreated. Muscle weakness is caused by low levels of magnesium and potassium.
How Celiac Disease is diagnosed
Symptoms associate with celiac disease may also be experienced in patients with other diseases such as Crohn’s disease and pancreatic problems (Blummer, 2010). It is therefore important to carry out necessary testing to confirm celiac disease. Some of the recommended tests include small intestinal biopsy and specific antibody tests. Blood tests may also be performed to check vitamin deficiencies.
Treatment of Celiac Disease
There is no known cure for celiac disease and therefore gluten free diet is used as a form of treatment (Thompson, 2006). Foods made from rye, barley and wheat should be avoided completely. Some tablets that might contain gluten should also be avoided by persons with celiac disease.
Drugs for Celiac Disease Treatment
Drugs used for the treatment of celiac disease are mostly food supplements for replacing nutrients that are lacking in the body (Fasano & Troncone, 2008). Some of the drugs include; Dapsone, Effexor, Levaquin, Nexium, Prozac, Probiotics, Synthroid, Protonix and many more.