Celiac Disease_Gastroenterology (Gowtham_503) (1).pptx

Gastroeneterology of celiac disease

1. Celiac Disease (Gastroenterology) Done by, Gowtham selvaraj_503

2. Introduction Celiac disease (CD) is a chronic, multiple-organ autoimmune disease that affects the small intestine in genetically predisposed children and adults. It is precipitated by the ingestion of gluten (form of protein found in grains) -containing foods . It may also be referred to as celiac sprue, gluten-sensitive enteropathy, or nontropical sprue.

3. Etiology Celiac disease results from a combination of immunological responses to an Environmental factor : gluten and related prolamin present in wheat, rye, and barley Genetic factor : Celiac disease is associated with HLA-DQ2 and -DQ8

4. Pathophysiology Genetics • The vast majority of celiac patients have one of two types of HLA DQ • Two of these variants— DQ2 and DQ8. The reason these genes produce an increase in risk of celiac disease is that the receptors formed by these genes bind to gliadin peptides more tightly than other forms of the antigen-presenting receptor. Prolamins • The majority of the proteins in food responsible for the immune reaction in celiac disease are the prolamins. These are storage proteins rich in proline and glutamine. Prolamins disrupt tight junctions between enterocytes which allow large amino acids to enter circulation and stimulate immune response

5. Tissue Transglutaminase : Anti-transglutaminase antibodies to the enzyme tissue transglutaminase (tTG) are found in an overwhelming majority of cases. •Tissue transglutaminase modifies gluten peptides into a form that may stimulate the immune system more effectively. Villous atrophy and malabsorption: The inflammatory process, mediated by T cells, leads to disruption of the structure and function of the small bowel's mucosal lining(villi) , and causes malabsorption as it impairs the body's ability to absorb nutrients, minerals and fat-soluble vitamins A, D, E and K from food

6. Symptoms of Celiac Disease Celiac disease (CD) may occur without any symptoms;asymptomatic or minimally symptomatic celiac disease is probably the most common form of the disease, especially in older children and adults Currently, 5 possible presentations of celiac disease are recognized, as follows Typical Atypical Silent Potential Latent

7. Typical : This presentation is primarily characterized by GI signs and symptoms.

8. Atypical : GI signs and symptoms are minimal or absent, and various extraintestinal manifestations are present.

9. Silent : The small intestinal mucosa is damaged , and celiac disease autoimmunity can be detected with serology; however, no symptoms are present. Potential : Patients have a positive specific autoimmune serology and may or may not be symptomatic, but the mucosa morphology is normal. These individuals have genetic compatibility with celiac disease and full-blown celiac disease may develop at a later stage in some or all of these individuals. Latent : Individuals with normal mucosal morphology who “have had a gluten-dependent enteropathy at some point in their life.” This subset of patients is the rarest of the group.

10. Diagnosis

11. Most patients with celiac disease have a small bowel that appears normal on endoscopies; however, five concurrent endoscopic findings have been associated with a high specificity for celiac disease:  scalloping of the small bowel folds  paucity in the folds  a mosaic pattern to the mucosa -cracked-mud appearance  prominence of the sub mucosal blood vessels  a nodular pattern to the mucosa Endoscopic findings

12. Key diagnostic findings include: Characteristic histopathologic changes in intestinal mucosal biopsies, including intraepithelial lymphocytosis, crypt hyperplasia, and various grades of villous atrophy. Evidence that small-intestinal enteropathy is dependent on gluten, which can be shown by positive celiac disease–specific antibodies and/or clinical and/or histological improvement in response to a gluten-free diet.

13. Treatment By diet Presently, the only effective treatment is a lifelong GLUTEN FREE DIET • Rice, soyabean, potato and corn flour are safe • No medication exists that will prevent damage, or prevent the body from attacking the gut when gluten is present. • Strict adherence to the diet allows the intestines to heal, leading to resolution of all symptoms in most cases Refractory Disease This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone • The patient is not adhering to the diet • Because the patient is consuming foods that are inadvertently contaminated with gluten • In this case steroids and immunosuppresents should be considered.

14. Complications

15. References https://www.worldgastroenterology.org/guidelines/celiac-disease/celiac-disease-english https://gi.org/topics/celiac-disease/#:~:text=Celiac%20disease%20(CD)%20is%20a,therefore%20susceptible%20to%20this%20disease.