A Comprehensive Review of Celiac Disease/Gluten-Sensitive Enteropathies

Abstract

Celiac disease is a complex immune-mediated gluten-sensitive enteropathy with protean clinical manifestations. It is manifest in genetically predisposed individuals who ingest gluten in varying amounts. In broad terms, it is thought to affect 1% of the population in the USA. More specifically, the prevalence increases drastically from 1:133 in patients not-at-risk, to 1:56 in symptomatic patients, to 1:39 in patients with a second-degree relative with the diagnosis, and to 1:22 in patients with a first-degree relative with the diagnosis. It may be associated with several immune-mediated phenomena, autoimmune diseases, and complicated by vitamin and other trace element deficiencies, bone disease, and malignancy. Our understanding of celiac disease has evolved rapidly over the past two decades. This has led to several lines of enquiry on the condition and potential treatment options. More recently, several entities including gluten intolerance, non-celiac gluten sensitivity, and seronegative celiac disease have been described. These conditions are distinct from allergies or intolerance to wheat or wheat products. There are challenges in defining some of these entities since a large number of patients self-report these conditions. The absence of confirmatory diagnostic tests poses an added dilemma in distinguishing these entities. The differences in spectrum of symptoms and highlights of the variability between the pediatric and adult populations have been studied in some detail. The role of screening for celiac disease is examined in both the general population and "at risk" populations. Diagnostic strategies including the best available serologic testing, utility of HLA haplotypes DQ2 and DQ8 which are seen in over 90% of patients with celiac disease as compared with approximately 40% of the general population, and endoscopic evaluation are also reviewed. Comprehensive nutritional management after diagnosis is key to sustained health in patients with celiac disease. Simple algorithms for care based on a comprehensive multidisciplinary approach are proposed. Refractory and non-responsive celiac diseases in the setting of a gluten-free diet are examined as are novel non-dietary therapies. Finally, the association of other disease states including psychiatric illness, infertility, lymphoproliferative malignancy, and mortality is explored with special attention paid to autoimmune and atopic disease.

Bidirectional relationship between eating disorders and autoimmune diseases

“…In addition, the strict gluten‐free diet effective in the treatment of celiac disease could adversely influence patients’ health‐related quality of life (Almagro, Almagro, Ruiz, González, & Martínez, ; McAllister, Williams, & Clarke, ), especially for adolescents (Mazzone et al., ). The permanent dietary restriction and vigilant monitoring necessary can foster preoccupation with, and anxiety about eating, potentially increasing the risk for pathological eating behaviors (Arigo, Anskis, & Smyth, ).…”

A case of celiac disease presenting with celiac crisis: rare and life threatening presentation

“…Type 1 Diabetes and Hypothyroidism are the most common autoimmune diseases associated with celiac disease although there is no specific name for this condition [2]. Our patient did not have other features (adrenal insufficiency, hypoparathyroidism, candidiasis, hypogonadism) to qualify for autoimmune polyglandular syndrome type 1 or 2.…”

“…Celiac disease is a multiple organ autoimmune disease precipitated by gluten proteins that affects small intestine in genetically predisposed children and adults [1]. The common manifestations of celiac disease are bulky, foul smelling diarrhea, abdominal distension and consequences of malabsorption such as failure to thrive, weight loss, anemia and osteopenia [2]. Celiac crisis is a life threatening manifestation of celiac disease especially in children and rarely in adults.…”

Osteoporosis Complicating Some Inborn or Acquired Diseases

“…In around 50 % of Danish population were HLA DQ2/DQ8 positive and therefore potentially risky for celiac disease (Karhus et al 2018). Similarly, approximately 90 % of celiac patients have a DQ2 or DQ8 haplotype, as compared with only 40 % of general population (McAllister et al 2018). The polymorphism beta57 in the HLA-DQ8 gene amplifies the T-cell activation and it is associated with an increased sensitivity of the body to gluten.…”