Celiac disease

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Celiac Disease: Pathophysiology, Sign and Symptoms, Diagnosis, Treatment, and Likely Complications

Over the years, diseases have reduced the quality of life lived by human beings around the world.  The health, social, and economic effects of diseases affect the quality of life and cause several deaths across the globe. Celiac disease is one of the diseases that afflict certain members of society across the globe.  According to Caio et al. (2019), celiac disease is an autoimmune digestive disorder that stems from the body's abnormal immune reaction to gluten.  The body's immune response to gluten in patients who have celiac disease causes damage to the villi in the small intestine, thus affecting the body's ability to absorb food. The body needs energy from absorbed food to operate optimally. Therefore, the damage to the small intestines that hinders optimal food absorption results in all the disease's negative effects.  

Statistics

Celiac disease has a high global prevalence.  One in every one hundred people suffers from the disease globally (Celiac Disease Foundation, 2020). Singh et al. (2018) asserts that celiac disease is hereditary; this is seen in the high number of people from the same family who suffer from it. One in every ten members from a family with a history of celiac disease suffers from the condition.  In America, the disease affects 1% of the population.  However, only 3% of the total number of those who have celiac disease are diagnosed (The University of Chicago Medicine, 2020).

Pathophysiology

Celiac disease is caused when people who are intolerant to gluten ingest foods that have gluten. Gluten, a protein found in products such as wheat, has a compound called gliadin. When ingested by people who are intolerant to gluten, the body treats the gliadin as a threat and responds through the release of antibodies supposed to eliminate the threat identified. The antibodies released cases the surface of the small intestine to become swollen and red. The small intestines play a vital role in the digestive system. Its inner wall has millions of small hairs called villi that increase the surface area for the absorption of nutrients found in digested food.  The inflammation of the small intestines changes the villi's shapes by flattening them, thus reducing their surface area, thus reducing the level of nutrients that can be absorbed in the body. The body autoimmune response to the presence of gluten by treating it as a threat to the body, therefore, causes celiac disease (Parzanese et al., 2017).

Signs and Symptoms

Patients suffering from celiac disease exhibit the following signs and symptoms. First, the patients suffer from weight loss. Parzanese et al. (2017) assert that weight loss is one of the signs of celiac diseases. The disease manifests by affecting the small intestine's normal operations, thus preventing it from absorbing nutrients during digestion.  This, therefore, causes the patients to lose weight.  Secondly, patients also suffer from constipation. Patients who have celiac disease are often constipated because of the following reasons. First, the damaged villi instead of absorbing nutrients absorb water, thus removing moisture as the food passes to the large intestines. This hardness the final end result making it hard to pass. A gluten-free diet also rids the patients of vital sources of fibers, which aid in preventing constipation. (Celiac Disease Foundation, 2020).

 The disease also causes iron deficiency anemia. Celiac disease impairs patients' ability to absorb nutrients from the food they eat.  Therefore, this results in the reduction of the level of iron absorbed in the body, leading to low red blood cells in the patients. Fatigue is also prevalent among patients suffering from celiac disease.  The body's reduction in its ability to absorb food rids it of a vital source of energy, thus resulting in the patients feeling fatigued. The condition also manifests through bloating. Celiac disease causes inflammation of the small intestines, thus resulting in bloating (Parzanese et al., 2017).

Apart from bloating, the disease also manifests through diarrhea. According to Parzanese et al. (2017), 79% of celiac patients reported having suffered diarrhea before being diagnosed with the condition. However, after their diagnosis and treatment, the number of those who continued experiencing diarrhea dropped to 17%. The disease also presents with symptoms such as nausea, abdominal pains, nervous system injury, dermatitis herpetiformis, and mouth ulcers.

Diagnosis

Doctors rely on a variety of factors in their diagnosis of celiac disease.  First, they consider risk factors. There are risk factors that predispose certain people to celiac disease. Such risk factors include a history of the disease in the family, Down Syndrome, Turner's syndrome, liver disease, and type 1 diabetes. Upon checking for the patients' history and the risk factors, the doctor than requests for a blood test to determine whether the patient has celiac disease. The blood test looks for the presence of certain antibodies that points to an immune response to the presence of gluten. However, for the test to be accurate, the patient needs to be on a diet that contains gluten before the test. Blood test look for the presence of elevated levels of anti-tissue transglutaminase (tTG), deamidated gliadin peptide (DGP) and endomysial antibodies (EMA) antibodies.

Apart from the blood test, the disease can also be diagnosed through genetic testing. The test looks for the presence of leukocyte antigens HLA-DQ2 and HLA-DQ8 genes. The presence of the genes points to the presence of the disease while their absence implies a negative result.  The disease can also be diagnosed through the use of endoscopy. Through this method, the doctor will use a tube with a camera that is inserted through the mouth to the small intestine. Through the camera, the doctor is able to see and assess the villi for any damage (Parzanese et al., 2017).

Treatment

Upon a successful diagnosis, the doctors the proceed to treat the condition. According to Parzanese et al. (2017), there are no medications that treat celiac diseases.  Therefore, doctors rely on the use of diet to help alleviate the painful symptoms of the disease. The widely use course of action is putting patients on a gluten-free diet.  Since the condition sets in due to the body's violent reaction to gluten, patients are advised to avoid taking foods that contain gluten. Ridding the body of gluten stops the immune responses, thus giving the small intestines time to heal.  Apart from food, such patients are also advised to avoid medications that contain gluten. Some tablets use starch from wheat as a binding agent.  Therefore, patients suffering from celiac disease should inform their doctors to avoid prescriptions of drugs that contain gluten as a component. 

Prognosis

Celiac disease is fatal in 10 to 30% of patients who have unresponsive celiac disease. This is a condition that keeps reoccurring even after the removal of the gluten that causes the immune response.  Patients whose condition does not respond to the dietary changes prescribed by the doctor often have negative outcomes that can become fatal. Severe cases of the disease coupled with its symptoms such as anemia and weight loss, can result in fatalities. Therefore, patients whose case is reoccurring and unresponsive have a poor prognosis.

 On the other hand, patients whose condition respond well to the gluten-free diet have an excellent prognosis. For such patients, they only need time for the small intestine to heal and resume its normal optimal operations.  The process of healings varies depending on age. In children, it takes between 3 to 6 months while in adults the damage to the villi heals in 2 to 3 years.  To maintain an excellent prognosis, the patients should endeavor to avoid taking any food, drink, or medication that has gluten (Caio et al., 2019).

Prevention

According to Mearin (2015), celiac disease has no known prevention method. Mearin (2015) opines that those who are predisposed to the condition cannot stop its development. Mearin (2015), therefore, asserts that the best way is to prevent the symptoms of the condition by adopting a gluten-free diet.  The diet ensures that the patients are protected from the negative immune response to glute that affects their small intestines. Mearin (2015) asserts that studies that proposed small but regulated introduction of gluten tot small predisposed children when they are between 4 and 6 months as a primary source of prevention proved unsuccessful. Therefore, secondary prevention remains the best way of preventing patients from suffering the negative effects of celiac disease.  This can be achieved through early screening and ensuring that those who have the condition adopt a gluten-free diet before suffering serious damage to their small intestines.

Complications

  The fact that celiac disease is difficult to accurately diagnose increases the risk of complications it poses to patients who are unknowingly suffering from the condition.  Depending on the duration one has suffered from the diseases before being diagnosed, it can result in the following health complications; first, lactose intolerant.  Lactose, which naturally occurs in milk, is often digested and absorbed by the small intestine.  Due to celiac disease, the damage to the villi prevents them from absorbing the lactose, which can make the patients' lactose intolerant.

Secondly, it increases patients' risk of developing osteopenia and osteoporosis. Calcium plays a vital role in the development of bones in the body.  The bones need calcium, which is supplied from the various types of food ingested.  The food is digested and the minerals such as calcium absorbed. For patients suffering from celiac disease, the body's ability to absorb nutrients from digested food is impaired due to the small intestine's inflammation, which affects the shape of the villi. This, therefore, exposes such patients to complications such as osteopenia and osteoporosis.

Apart from calcium deficiency, the disease also exposes patients to complications stemming from the deficiency of iron. Iron is a vital mineral needed in the formation of red blood cells.  The body's inability to adequately absorb the mineral from digested food at the small intestine leads to iron deficiency in the body, which exposes the patient to its related complications such as anemia. Women suffering from celiac disease often grapple with infertility.  Those who manage to conceive also often have high cases of miscarriage (Caio et al., 2019).

In conclusion, celiac disease is a medical condition that afflicts 1 in every 100 people globally.  The disease affects approximately 1% of the population of the United States.   The autoimmune conditions stem from the body's inability to tolerate gluten and therefore respond to its presence in the body as a threat.  The body of patients suffering from the diseases releases antibodies in the presence of gluten that affects the small intestine's ability to absorb nutrients. The diseases manifest through symptoms such as diarrhea, iron defiance anemia, constipation, and fatigue.  The disease has no known cure and can only be managed through adopting a gluten-free diet.