Celiac disease

Celiac disease is an autoimmune disorder that affects the small intestine and is triggered by the ingestion of gluten—a protein found in wheat, barley, rye, and oats. In people with celiac disease, the body's immune system mistakenly attacks the lining of the small intestine when gluten is consumed, leading to inflammation and damage to the villi (small finger-like projections that line the intestine and are responsible for absorbing nutrients).

Causes:

Celiac disease is caused by a combination of genetic and environmental factors:

• Genetics: The disease tends to run in families, and individuals with certain genes, particularly the HLA-DQ2 or HLA-DQ8 gene, are at higher risk.
• Environmental triggers: In addition to genetic factors, environmental triggers such as infections, surgery, pregnancy, or severe emotional stress can lead to the onset of celiac disease in genetically predisposed individuals.

Symptoms:

Symptoms of celiac disease can vary widely from person to person and can affect different parts of the body. The disease can range from mild to severe and may involve both digestive and non-digestive symptoms.

Digestive symptoms:

• Diarrhea or constipation
• Abdominal pain or bloating
• Gas and flatulence
• Fatigue after eating
• Unexplained weight loss or failure to thrive (especially in children)
• Nausea and vomiting

Non-digestive symptoms:

• Anemia (due to iron deficiency)
• Joint pain or swelling
• Skin rashes, particularly dermatitis herpetiformis (an itchy, blistering rash on the elbows, knees, and buttocks)
• Bone loss or osteoporosis
• Headaches and migraines
• Infertility or miscarriage
• Fatigue, irritability, or depression

Diagnosis:

Celiac disease can be difficult to diagnose because its symptoms overlap with many other conditions. A blood test for elevated levels of specific antibodies (such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA)) is typically the first step in diagnosis. If these antibodies are present, a biopsy of the small intestine may be performed to confirm damage to the villi and the diagnosis of celiac disease.

Complications:

If left untreated, celiac disease can lead to a number of complications, including:

• Nutritional deficiencies: Damage to the intestine impairs nutrient absorption, leading to deficiencies in iron, calcium, vitamin D, and other important nutrients.
• Osteoporosis: Due to poor absorption of calcium and vitamin D, people with untreated celiac disease are at higher risk for bone thinning and fractures.
• Infertility and miscarriage: Celiac disease can cause reproductive problems in both men and women.
• Neurological issues: These include peripheral neuropathy (nerve damage causing numbness or tingling in the hands or feet) and ataxia (balance and coordination problems).
• Intestinal cancers: People with celiac disease are at a slightly increased risk for developing certain types of cancers, such as small bowel lymphoma or esophageal cancer, particularly if the disease is untreated.
• Liver disease: In rare cases, untreated celiac disease can lead to liver damage and associated conditions, including cirrhosis.

Treatment:

The only effective treatment for celiac disease is a strict, lifelong gluten-free diet. This means avoiding all foods and products that contain wheat, barley, rye, and oats. A gluten-free diet allows the small intestine to heal, reduces symptoms, and prevents further damage to the intestine.

• Gluten-free foods: People with celiac disease should eat foods naturally free of gluten, such as fruits, vegetables, meat, fish, eggs, and most dairy products.
• Gluten-free substitutes: Many gluten-free substitutes, such as rice, quinoa, and gluten-free flours (like rice flour, almond flour, and potato flour), are available in grocery stores.
• Vitamins and supplements: Due to nutritional deficiencies, people with celiac disease may need to take vitamin and mineral supplements, especially iron, calcium, and vitamin D, as well as folic acid.
• Monitoring: Regular follow-up with healthcare providers is necessary to ensure adherence to the gluten-free diet and to monitor for any complications or nutritional deficiencies.

Prognosis:

With strict adherence to a gluten-free diet, the prognosis for individuals with celiac disease is generally good. Most people experience relief from symptoms and can expect their small intestine to heal over time. However, if gluten is reintroduced into the diet, symptoms may return, and further damage to the intestine can occur.

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