What causes celiac disease and how is it managed?

From the Guidelines

Celiac disease is an autoimmune disorder caused by a genetic sensitivity to gluten, a protein found in wheat, barley, and rye, and the only effective management is a strict, lifelong gluten-free diet. When people with celiac disease consume gluten, their immune system attacks the small intestine, damaging the villi that absorb nutrients. This damage can lead to malabsorption of essential nutrients, causing a range of symptoms including diarrhea, nausea, vomiting, abdominal pain, fatigue, and weight loss 1.

Causes of Celiac Disease

The exact causes of celiac disease are not fully understood, but it is known to be triggered by the ingestion of gluten in individuals with a genetic predisposition, particularly those with HLA-DQ2 and HLA-DQ8 molecules 1. The disease is characterized by an immune-mediated response to gluten, leading to inflammation and damage in the small intestine.

Management of Celiac Disease

The management of celiac disease involves a strict, lifelong gluten-free diet, which is the only effective treatment for the condition 1. Patients must carefully read food labels for hidden sources of gluten and be aware of cross-contamination risks in food preparation. Nutritional supplements may be needed initially to address deficiencies, particularly iron, calcium, vitamin D, zinc, and B vitamins. Regular follow-up with healthcare providers is important to monitor symptoms and nutritional status.

Monitoring and Follow-up

Monitoring and follow-up are crucial in the management of celiac disease, with regular checks on intestinal absorption, associated autoimmune conditions, liver disease, and dietary adherence 1. The use of serology, such as anti-TG2 or EMA/DGP, can be helpful in monitoring disease activity, but it is not a substitute for a structured dietary interview.

Quality of Life and Adherence

Adherence to a gluten-free diet can be challenging, and patients may experience social and financial burdens. Lack of compliance can lead to deterioration of quality of life, ongoing malabsorption, anemia, and osteoporosis 1. A team-based approach, including a dietician, can help improve adherence and provide practical advice on lifestyle and food choices.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Celiac Disease Causes

• Celiac disease is a chronic disease causing inflammation of the proximal small intestine that occurs in genetically predisposed individuals when they eat gluten, which is the storage protein in wheat, barley, and rye 2.
• The disease is triggered by an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals 3.
• Three main pathways cause celiac disease: the environmental trigger (gluten), genetic susceptibility, and unusual gut permeability 4.
• The disease is closely associated with genes that code for human leukocyte antigens DQ2 and DQ8 5.

Celiac Disease Management

• The cornerstone of treatment for celiac disease is elimination of gluten from the diet 2.
• A strict gluten-free diet (GFD) alone should result in complete symptomatic and histologic resolution of the disease and reduce risk of complications 2.
• Noncompliance with diet is the leading cause of failure to respond in patients with celiac disease 2.
• Alternative treatments are being developed, including engineering gluten-free grains, decreasing intestinal permeability, inducing oral tolerance to gluten with a therapeutic vaccine, and degrading immunodominant gliadin peptides using probiotics with endopeptidases or transglutaminase inhibitors 4.
• A gluten-free diet is the mainstay of safe and effective treatment of celiac disease, although its effect on some of the extraintestinal manifestations of the disease remains to be determined 5.

Nutritional Consequences

• Celiac disease represents a major health issue, with the immune-mediated response resulting in villous atrophy of the small intestine with subsequent malabsorption 6.
• The classic mode of presentation is that of a malabsorption syndrome resulting in deficiencies of macro and micronutrients 6.
• Though initiation of the gluten-free diet results in improvement of symptoms and most deficiencies, certain nutritional limitations are associated with the gluten-free diet 6.