CELIAC DISEASE

Celiac disease is caused by an immunological reaction against a lower protein called gliadin, which is caused by the destruction of wheat, barley, rye and gluten protein found in oats in people with an underlying genetic predisposition. In the first picture, there is a normal duodenum.

Especially in the upper parts of the small intestine, damage occurs on the mucosal absorption surface, the pilis are deleted, and pecten and oedema may occur. When this condition progressed, absorption disorder will occur. In the second picture, there is a duodenum in a celiac patient.

What is the frequency of celiac disease?

In Western societies, it is around 1%. Besides that, the frequency increases in people with celiac disease in their families, people with Type 1 diabetes, and people with down syndrome.

• It is 2 or 3 times more common in women.
• The frequency in society is around 1%.
• The incidence is 0.2/100 and prevalence is around 1%.
• Prevalence is around 2.25% in people at risk.
• Cancer predisposition
  • Lymphoma, Non-Hodgkin Lymphoma, Esophageal cancer, Melanoma, stomach and small intestine cancers increased.
  • Breast cancer decreased
  • Colon cancer did not increase
• Diseases that may accompany celiac disease
  • Dermatitis herpetiformis
  • Other skin symptoms
    • Drying on the skin
    • Vitiligo
    • Finger clubbing
  • Shogren syndrome
  • Rheumatoid arthritis
  • IgA deficiency
  • Type 1 diabetes – 8%
  • Thyroid diseases 8%
  • Ig A nephropathy
  • Increased risk of epilepsy
  • NASH, PBS, autoimmune cholangiopathy
  • A high liver enzyme in 3.8% of celiac patients

What are the complaints, the signs, and the symptoms of celiac disease?

The complaints and symptoms you can see in celiac disease are:

• Diarrhea,
• Constipation (rarely),
• Nausea and vomiting,
• Abdominal pain,
• Abdominal distension,
• Gas and bloating,
• Excessive flatulence,
• Eczematous changes in the skin (dermatitis herpetiformis)
• Malabsorption,
• Growth deficiency for children,
• Delayed puberty,
• Amenorrhea,
• Iron deficiency anaemia,
• Osteoporosis,
• An unexplained high liver enzyme,

Cancer predisposition

• • Lymphoma, Non-Hodgkin Lymphoma, Esophageal cancer, Melanoma, stomach and small intestine cancers have increased.
  • Breast cancer decreased
  • Colon cancer did not increase

Diseases that may accompany celiac disease

• • Dermatitis herpetiformis
  • Other skin symptoms
    • Drying on the skin
    • Vitiligo
    • Finger clubbing,
  • Schogren syndrome,
  • Rheumatoid arthritis,
  • Iga deficiency,
  • Type 1 diabetes – 8%
  • Thyroid diseases 8%
  • Ig A nephropathy
  • Increased risk of epilepsy
  • NASH, PBS, autoimmune xolangiopathy
  • A high liver enzyme in 3.8% of celiac patients

How to diagnose celiac disease and what tests should be applied for that?

In patients over 2 years old: Initial screen test for celiac disease should be anti-tissue transglutaminases igA.

• If the IgA tTG Level > is more than 10 times normal, antiendomist antibodies and human leukocyte antigen (HLA)-DQ serotypes may not be required biopsies.
• HLA-DQ2 or DQ8 genotypes: If both are negative, the possibility of celiac disease does not exist.
• In suspicious cases, multiple biopsies from the bulbous and duodenum distal are needed.
• It is recommended to look at haemoglobin, Iron, folate, vitamin B12, calcium, and vitamin D to understand if there is a lack of nutrition in the patient.

Lab tests for celiac disease

Serology

• Anti tissue transglutaminase Ig G and Ig A
• Anti-endomysium antibodies Ig G and Ig A
• Anti deaminated gliadin Ig G and Ig A

Endoscopy

• Duodenal biopsy is taken
• Partial or full blunting in the villuses
• Elongation in crypts
• Modified Marsh classification
  • Type 0 – No intra-epithelial lymphocyte surged, no crypt hyperplasia, no villus atrophy.
  • Type 1 – Intra-epithelial Lymphocyte increase (> 40 /100 enterocyte), but no crypt hyperplasia, no villus atrophy.
  • Type 2 – Intra-epithelial Lymphocyte increase (>40 /100 enterocyte), has crypt hyperplasia, but no villus atrophy.
  • Type 3 – increased intraepithelial lymphocytes ( >40/100 enterocytes), faulty enlargement, villus atrophy
  • Type 3a – partial villus atrophy
  • Type 3b – subtotal villus atrophy
  • Type 3c – total villus atrophy

Gluten Challenge test

In cases of suspicion in the diagnosis of celiac disease or, because it is already on a gluten-free diet during the testing process in non-diagnostic patients, its tests are restarted into gluten. Within 3 to 6 months, mucosal changes are observed with serological tests and duodenal biopsy. Then, the gluten-poor diet is started and recovery is seen.

Capsule endoscopy

In cases where serology is negative but villus atrophy is present, capsule endoscopy contributes to diagnosis.

What diseases should come to mind in the differential diagnosis of celiac disease?

Other diseases that make villous atrophy in small intestine biopsy

• • Tropical sprue
  • Collagenous sprue (refractory state, 50% respond to steroids)
  • Autoimmune enteropathy
  • AIDS enteropathy
  • Acute malnutrition
  • Food protein hypersensitivity
  • Whipple disease
  • Crohn disease
  • Hypogammaglobulinemia
  • Abetalipoproteinemia
  • Intestinal lymphoma
  • Intestinal tuberculosis
  • Excessive proliferation of bacteria in the small intestine
  • Small bowel ischemia
  • Eosinophilic gastroenteritis
  • Infectious enteritis
  • Giardiasis
  • Parasitic infestation
  • Graft-versus-host disease
  • Drug-dependent enteropathy (e.g. olmesartan)
• Allergic enterocolitis (allergic to milk protein, soy and rice allergy)
• Other causes of nutritional deficiency
  • Lactose intolerance
  • Fructose intolerance
  • Tropical sprue
  • Pancreatic insufficiency
  • Crohn disease
  • Pernicious anemia
• Infectious gastroenteritis
• Microscopic colitis

How to treat celiac disease? Is diet mandatory?

• Dietary treatment is mandatory in celiac disease. A strict gluten-free diet is absolutely necessary. Help should be taken from a dietitian specializing in this issue.
• If there are nutritional deficiencies, they should be completed. Vitamins and trace elements should be completed.
• Growth in children should be followed.
• The stories of people with celiac disease should be taken in regard to adaptation with diet, and diets should be followed.
• Bone density measurement should be checked from time to time.
• Studies are being carried out on drugs that eliminate the need for diet in celiac disease. However, an agent that has been routinely on sale as a drug has not yet been approved.