Celiac Disease




Celiac Disease
Celiac Disease


Gluten-induced Enteropathy

Is a mal-absorption disease of the proximal small intestine , that is characterized by abnormal mucosa with permanent intolerance to gluten .

Celiac Disease

Etiology :

1. unknown .
2. genetics .
3. toxic .
4. allergic .

Altered physiology :


Characteristics of the disease include :

- Impaired intestinal absorption .

- Histological abnormalities of small intestine .

- Clinical and histological improvement with gluten-free diet .

- Recurrence of clinical manifestations and histological changes after reintroduction of dietary gluten .

Histological changes :

- Loss of normal villous pattern .

- Obliteration of intervillous spaces .

- Loss of epithelial cell brush border .

These changes result in disaccharide deficiency , inability to absorb fates , fat-soluble vitamins , minerals and some proteins and carbohydrates .

Mal-absorption result from decreased area of absorption .

Clinical manifestations :

- Diagnoses is most commonly made at 6-24 months of age ( it can be made in adult .

- Chronic or recurrent diarrhea ( foul . bulky , and greasy stool ) .

- Anorexia , vomiting , abdominal distention , muscle wasting and hypotonia .

- Steatorrhea .

- Malnutrition .

- Weight loss and dehydration .

- Mood changes ( irritability and nervousness ) .

- Secondary deficiencies such as anemia , hypocalcaemia and hypoproteinemia .

Diagnostic evaluations :

- History and general status .

- Small bowel biopsy .

- D-xylose test ( less than 20-25mg/dl at 60 minute ) .

- Hb level .

- Stool test ( fecal fat excretion ).

- Sweet test ( to rule out cystic fibrosis ) .

- X-ray .

Treatment :

- Lifelong gluten free diet .

- Adequate caloric intake .

- Supplemental vitamins .

- Decreased fat intake .

Treatment of celiac crisis :-

1. Restore fluid and electrolyte balance .

2. Parenteral hyperalimination .

3. Steroids .



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