Update on Celiac Disease

Author: Anne D. Walling
Date: March 15, 2001

(Australia--Australian Family Physician, September 2000, p. 835.) Celiac disease most commonly affects persons of Western European decent. In Australia, the prevalence may be more than one per 300 to 500 persons. Many of these cases remain subclinical while many more are misdiagnosed. Diagnosis can also be delayed because the presentation is highly variable. Celiac disease is an autoimmune response to the ingestion of prolamines in the gluten contained in wheat, barley and rye. The prolamines form complexes with tissue transglutaminase and these complexes stimulate an antigenic response from the mucosal T cells of the small intestine. The resulting damage to the intestinal mucosa can cause malabsorption. Clinically, celiac disease may present as a spectrum of conditions, from severe malabsorption to vague gastrointestinal symptoms and anemia in adults. An increasing number of cases are recognized as part of the diagnostic investigation of unexplained female infertility, recurrent miscarriage, disorders of calcium metabolism, or anemia secondary to iron or folate deficiency. Although biopsy of the small intestine is the conclusive diagnostic test, immunoglobulin A antibody tests that measure transglutaminase or endomysial antibodies are becoming more widely available. The management of celiac disease depends on the elimination of gluten from the diet and the correction of nutritional deficiencies. Support groups can be invaluable in maintaining compliance and helping families to manage the condition.

COPYRIGHT 2001 American Academy of Family PhysiciansCOPYRIGHT 2001 Gale Group

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