Celiac Disease

Abstract

Triggered by the ingestion of gluten in genetically predisposed individuals, celiac disease is the most common genetically based food intolerance in the world, with a prevalence among approximately 1% of the general population. This enteropathy may appear at any age and is characterized by a wide variety of clinical signs and symptoms that go well beyond the gastrointestinal tract. In young children, gastrointestinal presentations are common and include chronic diarrhea, failure to thrive, and abdominal distention; however, extraintestinal manifestations are becoming increasingly more common. They include numerous conditions such as dermatitis herpetiformis, anemia, dental enamel hypoplasia, recurrent oral aphthae, short stature, osteoporosis, arthritis, neurologic problems, unexplained elevation of transaminase levels, and female infertility. Therefore, diagnosing celiac disease requires a high degree of suspicion, followed by correct screening and a confirmatory test with an intestinal biopsy. After diagnosis, a strict gluten-free diet must be followed, which in most cases will bring a marked improvement of symptoms. However, there are important compliance and quality-of-life problems, especially in adolescents.

Coeliac disease and gluten-related disorders in childhood

“…Extraintestinal symptoms such as arthritis, neurological symptoms and anaemia are also frequent. 2,44 In addition, coeliac disease can be asympto matic, as was the case for 43% of the children identified by family screening. 17 Autoantibodies Specific coeliac disease autoantibodies are detected in the serum against TG2 (TG2A), endomysium (EMA), and deamidated gliadin peptides (DGPA).…”

Does the microbiota play a role in the pathogenesis of autoimmune diseases?

“…Coeliac disease, like other autoimmune conditions, requires genetic susceptibility and environmental influences 62 63. This autoimmune disease is unique in that the main environmental factor is known, well characterised and therapeutically targeted.…”

“…Gluten, composed of gliadin peptides and glutenin, evokes a predominantly T cell mediated mucosal response in the proximal small bowel,64 with the cytokine interleukin (IL) 15 playing a pivotal role in the immunopathogenesis 65. This results in the characteristic pathological characteristics of progressive villous atrophy, distorted crypt architecture and increase in intraepithelial cells, leading to a reduction in absorptive capacity and emergence of GI and extraintestinal symptoms 62 63 66. However, there is often a lag of many years after gluten exposure until disease manifests serologically or clinically.…”

Extraintestinal Manifestations of Celiac Disease

“…The current awareness of CD complications in combination with the advent of highly sensitive and specific serological tests has dramatically increased the identification of patients among subjects having a higher risk for the disorder [3]. Case finding is now becoming more common and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms (diarrhea, abdominal pain and distension), failure to thrive in children [4,5], prolonged fatigue [6], unexpected weight loss, recurrent aphthous stomatitis, anemia [7], increased liver transaminases [8] and unexplained neuropsychiatric disorder [9]. Case finding is also recommended in conditions that associate with CD such as autoimmune thyroid disease, dermatitis herpetiformis (DH) and type 1 diabetes [7], and in patients with irritable bowel syndrome associated with diarrhea and first-degree relatives of celiacs [10,11].…”