Question

Explain the pathogenesis with common clinical presentation of celiac's disease

Answer 1

1) Celiac disease is a chronic immune based enteropathy caused by dietary gluten, a protein found in wheat, barley and rye. It is also called celiac sprue or gluten sensitive enteropathy.

Symptoms:

a) Diarrhoea

b) fatigue

c) weight loss

d) Nausea and vomiting

e) Abdominal pain and bloting

f) Anaemia

g) iron and donate malabsorption etc.

Pathogenesis :

Celiac disease appears to be polyfactorial, both in that more than one genetic factor can cause the disease and also more than one factor is necessary for the disease to manifest in a patient.

a) Genetic factor:

- The vast majority of celiac patients have one of two types of HLA DQ.

- Two of this variants - DQ2 and DQ8 - are associated wish celiac disease.

- 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.

b) Prolamins:

- The majority of the proteins in the food responsible for the immune reaction in celiac disease are the prolamins.

- Prolamins disrupt tight junctions between electrolytes which allow large amino acids to enter circulation and stimulate immune response.

c) Tissue Transglutaminase:

- Anti-transglutaminase antibodies to the enzyme tissue transglutaminase are found in an overwhelming majority of cases.

- Tissue transglutaminase modifies gluten peptides into a form that may stimulate the immune system more effectively.

d) Villous atrophy and malabsoption:

- The inflammatory process, medicated by T cells, leads to disruption of the structure and function of the small bowel's mucosal lining and causes malabsorption as it impaires the body's ability to absorb nutrients, minerals and fat soluble vitamins A, D, E and K from food.

-Lactose intolerance may be present due to:-

- Decreased bowel surface

- Reduced production of lactase but typically resolves once the condition is treated.

e) Risk modifiers:

- Infection by Rota virus

- Human intestinal adeno virus

- That smoking is protective against adult onset celiac disease.

- Timing of exposure to gluten in childhood is an important risk modifier.

- Prolonging breastfeeding until the introduction of gluten- containing grains into the diet is associated with a 52% of reduced risk of developing celiac disease in infancy.