What is celiac disease?

Celiac

What Is Celiac Disease ?

Celiac or coeliac is a disease caused by intolerance to a protein called Gliadin, which contains, along with another protein named glutenin, the Gluten that can be found in certain grains.

Some researches claim that the glutenin and not just the gliadin contain components that are harmful for celiac patients.

The gliadin is a glycoprotein (a complex protein with sugar).The glutenin gives the dough its stableness due to its molecular structure.

The gluten in the seed is mixed with starch and is botanically located in the endosperm (a tissue that feeds the seed while it grows).The gluten is mostly found in grains like wheat, barley and rye. In wheat, for example the gluten constitutes about %80 of the seed’s protein and it’s responsible for the dough’s elasticity and for the ability of the yeast to leaven.

Celiac is an autoimmune disorder. The immune’s cells mistakenly label the absorbed gliadin as pathogenic invader. The immune system attacks the intestinal cells; causing damage and interfere with the absorption process.

Due to the fact that in most cases the disease is asymptomatic, and the symptoms are not specific, it is estimated that rate / distribution of the disease if far greater than expected. Some estimate the rate at about %1-%2.

Causes:

 At this point the causes of the disease are still not completely clear, but it is known that genetic predisposition is strongly linked to them.

A study conducted in 2005 shows that the disease erupts in many cases when the lymph tissues are not functioning properly which cause to low or no discharge of “secretory immune-globulin A” (a substance that neutralize the effect of gluten) at all.  The conclusion of this study is that gluten is harmful by definition, but most people are protected from it. On the other hand most of the doctors feel that this assumption is not established yet.

Some speculate that the cause of the disease is a certain pathogen, probably a virus; some suggest that mental stress is also linked.

History:

The name celiac comes from the ancient Greek word “koiliakos” which means stomach or stomach aches.

The first to describe the disease was a Greek doctor called (Claudius Galenus, 129-199).

In 1888 the British doctor, Samuel Jones Gee , (1839-1911) , described the disorder in grater details. Doctor Samuel recommended a starch free diet as the only cure.

In 1908 the American doctor, Christian Archibald Herter recommended patients to avoid carbohydrates and to consume only protein and fat.

In 1918 the pediatrician sir Frederick Still recommended to avoid bread .In 1936 a study conducted in the children’s hospital Giuliana, by Willem Dicke, found that removing bread and flour from sick kids diet helped in improving their symptoms.

In the 60′s a researcher named Rubin discovered the small intestine biopsy which remains the main method of diagnose.

Diagnosis:

Celiac disease comes in many shapes and forms, and sometimes there are is no clinical expression at all. When the disorder appears in its classical form it’s fairly easy to detect, unfortunately in most cases the disorder comes in many ways and forms which makes the diagnose challenging. Some studies suggest that the ratio between diagnosed to undiagnosed patients is 1:10, hinting that the diagnosed cases are just the tip of the iceberg.

Patients with this disorder are often diagnosed with low levels of the hormone cholecystokinin.

Classic symptoms:  

 In its classic form (rare these days) the disorder presents children with growth problems, low body weight, thin limbs, swelling of the stomach or stomach pain, nausea, increased bowel movement, and smelly and pale feces.

In laboratory tests it’s not uncommon to detect anemia, and low levels of iron.

Women that are diagnosed and not avoiding gluten may experience infertility, abortions, premature birth and preterm infants. Patients that don’t watch their diet may develop lymphoma of T cells.

Biopsy:

 The only almost certain way to diagnose the disorder today is by a biopsy of the small intestine using an endoscope. Examining the biopsy will reveal scares and degeneration of the villi intestinales (small hair-like structures that comes out of the small intestine to improve absorption of nutrients). A small percentage of patients will show a false-negative result (they do have celiac but the biopsy wont show it).another case where a biopsy can’t help is after a long period of gluten free diet. This phenomenon suggests that the average time it takes the small intestine to heal is about 2 years.

 Genetic tests:

 In the early 80′s of the 20 century researchers found a way to measure the gliadin antibodies (Immunoglobulin) type IgA, IgG as an indicator of celiac. After a few studies it was found that the method is not so reliable since many people have gliadin antibodies and don’t have celiac .The method was refined to test IgA antibodies alone (rather than IgA and IgG) since they are more common with celiac patients. On the other hand this test is also not completely reliable, since many people (about 1 out of 700) is lacking the IgA antibody.

In conclusion – the test is fairly reliable on population that is not lacking the IgA antibody and in case there are no suspicious phenomenon’s it requires a biopsy only if the test was positive.

Endomysial and transglutaminase antibodies:

 In 1984 researches found a distinctive link between an antigen antibody named endomysium and celiac disorder, a few years latter they also found another antigen called transglutaminase which produces the same antibody. The connection between gluten or giladin, and those 2 antigens is unclear.As in the above tests, the test is fairly reliable on IgA antibodies alone.

Treatment:

 The only effective treatment is maintaining a completely gluten free diet for life. A very small amount of gluten is enough to cause health damage.Foods that need to be avoided are: wheat, barley and rye.A problematic issue: oat. Oat itself is gluten free but since a lot of oat is marketed along with other grinds that contain gluten, it is best to avoid it unless the package says otherwise.

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