Post by Master Kim on Jan 28, 2015 15:25:09 GMT -5
Coeliac disease - en.wikipedia.org/wiki/Coeliac_disease
Coeliac disease (/ˈsiːli.æk/; celiac disease in the United States and often celiac sprue) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include pain and discomfort in the digestive tract, chronic constipation and diarrhea, failure to thrive (in children), anaemia and fatigue, but these may be absent, and symptoms in other organ systems have been described. Vitamin deficiencies are often noted in people with coeliac disease owing to the reduced ability of the small intestine to properly absorb nutrients from food.
Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other common grains such as barley and rye). Upon exposure to gliadin, and specifically to three peptides found in prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.
Increasingly, diagnoses are being made in persons without symptoms as a result of increased screening. Globally coeliac disease affects between 1 in 100 and 1 in 170 people; rates do however vary between different regions of the world from as few as 1 in 300 to as many as 1 in 40.
This condition has several other names, including c(o)eliac sprue, nontropical sprue, endemic sprue, and gluten enteropathy. The term coeliac derived from the Greek κοιλιακός (koiliakós, "abdominal") and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by Aretaeus of Cappadocia.
Biopsy of en:small bowel showing en:coeliac disease manifested by blunting of en:villi, crypt hyperplasia, and en:lymphocyte infiltration of crypts, consistent with Marsh classification III. Released into public domain on permission of patient. -- Samir धर्म 11:23, 13 August 2006 (UTC)
Signs and symptoms
Severe coeliac disease leads to the characteristic symptoms of pale, loose and greasy stool (steatorrhoea) and weight loss or failure to gain weight (in young children). People with milder coeliac disease may have symptoms that are much more subtle and occur in other organs than the bowel itself. It is also possible to have coeliac disease without any symptoms whatsoever. Many adults with subtle disease only have fatigue or anaemia.
Gastrointestinal
The diarrhea that is characteristic of coeliac disease is (chronic) pale, voluminous and abnormally malodorous. Abdominal pain and cramping, bloatedness with abdominal distension (thought to be due to fermentative production of bowel gas) and mouth ulcers may be present. As the bowel becomes more damaged, a degree of lactose intolerance may develop. Frequently, the symptoms are ascribed to irritable bowel syndrome (IBS), only later to be recognised as coeliac disease; a small proportion of people with symptoms of IBS have underlying coeliac disease, and screening for coeliac disease is recommended for those with IBS symptoms.
Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel (enteropathy-associated T-cell lymphoma (EATL) or other non-Hodgkin's lymphomas). This risk is also higher in first-degree relatives like siblings, parents and children, whether or not a gluten-free diet brings this risk back to baseline is not clear. Long-standing and untreated disease may lead to other complications, such as ulcerative jejunitis (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring with obstruction of the bowel).
Malabsorption-related
The changes in the bowel make it less able to absorb nutrients, minerals and the fat-soluble vitamins A, D, E, and K.
Miscellaneous
Coeliac disease has been linked with a number of conditions. In many cases, it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.
Coeliac disease is associated with a number of other medical conditions, many of which are autoimmune disorders: diabetes mellitus type 1, hypothyroidism, primary biliary cirrhosis, and microscopic colitis.
A more controversial area is a group of diseases in which antigliadin antibodies (an older and nonspecific test for coeliac disease) are sometimes detected but no small bowel disease can be demonstrated. Sometimes these conditions improve by removing gluten from the diet. This includes cerebellar ataxia, peripheral neuropathy, schizophrenia, and autism.
Coeliac disease (/ˈsiːli.æk/; celiac disease in the United States and often celiac sprue) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include pain and discomfort in the digestive tract, chronic constipation and diarrhea, failure to thrive (in children), anaemia and fatigue, but these may be absent, and symptoms in other organ systems have been described. Vitamin deficiencies are often noted in people with coeliac disease owing to the reduced ability of the small intestine to properly absorb nutrients from food.
Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other common grains such as barley and rye). Upon exposure to gliadin, and specifically to three peptides found in prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.
Increasingly, diagnoses are being made in persons without symptoms as a result of increased screening. Globally coeliac disease affects between 1 in 100 and 1 in 170 people; rates do however vary between different regions of the world from as few as 1 in 300 to as many as 1 in 40.
This condition has several other names, including c(o)eliac sprue, nontropical sprue, endemic sprue, and gluten enteropathy. The term coeliac derived from the Greek κοιλιακός (koiliakós, "abdominal") and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by Aretaeus of Cappadocia.
Biopsy of en:small bowel showing en:coeliac disease manifested by blunting of en:villi, crypt hyperplasia, and en:lymphocyte infiltration of crypts, consistent with Marsh classification III. Released into public domain on permission of patient. -- Samir धर्म 11:23, 13 August 2006 (UTC)
Signs and symptoms
Severe coeliac disease leads to the characteristic symptoms of pale, loose and greasy stool (steatorrhoea) and weight loss or failure to gain weight (in young children). People with milder coeliac disease may have symptoms that are much more subtle and occur in other organs than the bowel itself. It is also possible to have coeliac disease without any symptoms whatsoever. Many adults with subtle disease only have fatigue or anaemia.
Gastrointestinal
The diarrhea that is characteristic of coeliac disease is (chronic) pale, voluminous and abnormally malodorous. Abdominal pain and cramping, bloatedness with abdominal distension (thought to be due to fermentative production of bowel gas) and mouth ulcers may be present. As the bowel becomes more damaged, a degree of lactose intolerance may develop. Frequently, the symptoms are ascribed to irritable bowel syndrome (IBS), only later to be recognised as coeliac disease; a small proportion of people with symptoms of IBS have underlying coeliac disease, and screening for coeliac disease is recommended for those with IBS symptoms.
Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel (enteropathy-associated T-cell lymphoma (EATL) or other non-Hodgkin's lymphomas). This risk is also higher in first-degree relatives like siblings, parents and children, whether or not a gluten-free diet brings this risk back to baseline is not clear. Long-standing and untreated disease may lead to other complications, such as ulcerative jejunitis (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring with obstruction of the bowel).
Malabsorption-related
The changes in the bowel make it less able to absorb nutrients, minerals and the fat-soluble vitamins A, D, E, and K.
- The inability to absorb carbohydrates and fats may cause weight loss (or failure to thrive/stunted growth in children) and fatigue or lack of energy.
- Anaemia may develop in several ways: iron malabsorption may cause iron deficiency anaemia, and folic acid and vitamin B12 malabsorption may give rise to megaloblastic anaemia.
- Calcium and vitamin D malabsorption (and compensatory secondary hyperparathyroidism) may cause osteopenia (decreased mineral content of the bone) or osteoporosis (bone weakening and risk of fragility fractures).
- Selenium malabsorption in coeliac disease combined with low selenium content in many gluten-free foods put patients at risk of selenium deficiency.
- Copper and zinc deficiencies have also been associated with coeliac disease.
- A small proportion have abnormal coagulation due to vitamin K deficiency and are slightly at risk for abnormal bleeding.
Miscellaneous
Coeliac disease has been linked with a number of conditions. In many cases, it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.
- IgA deficiency is present in 2.3% of people with coeliac disease, and in turn this condition features a tenfold increased risk of coeliac disease. Other features of this condition are an increased risk of infections and autoimmune disease.
- Dermatitis herpetiformis; this itchy cutaneous condition has been linked to a transglutaminase enzyme in the skin, features small-bowel changes identical to those in coeliac disease, and may respond to gluten withdrawal even if there are no gastrointestinal symptoms.
- Growth failure and/or pubertal delay in later childhood can occur even without obvious bowel symptoms or severe malnutrition. Evaluation of growth failure often includes coeliac screening.
- Pregnancy complications in case of coeliac disease as an intercurrent disease in pregnancy, with significant complications including miscarriage, intrauterine growth restriction, low birthweight and preterm birth.
- Hyposplenism (a small and underactive spleen);[19] this occurs in about a third of cases and may predispose to infection given the role of the spleen in protecting against bacteria.
- Abnormal liver function tests (randomly detected on blood tests).
Coeliac disease is associated with a number of other medical conditions, many of which are autoimmune disorders: diabetes mellitus type 1, hypothyroidism, primary biliary cirrhosis, and microscopic colitis.
A more controversial area is a group of diseases in which antigliadin antibodies (an older and nonspecific test for coeliac disease) are sometimes detected but no small bowel disease can be demonstrated. Sometimes these conditions improve by removing gluten from the diet. This includes cerebellar ataxia, peripheral neuropathy, schizophrenia, and autism.
subdue ST41 and LR2.