Brooke Bryant

Diet Instruction
Celiac Disease
April 28, 2016
KNH413

14 year old James Riggs is 57 his normal body weight is 140lb.James was recently diagnosed
with celiac disease. He was admitted to the hospital 4 months ago with abdominal pain, nausea,
bloating around the midsection, diarrhea and vomiting. James has recently had a weight loss of
10lbs reducing his weight down to 130lb in 2 months. James is very active in sports but has
lately been very fatigued and does not want to participate in the activities and sports that he
usually enjoys. James complains of not feeling good after eating meals and has recently started to
skip meals to avoid the uncomfortable bloating, abdominal pain, diarrhea and vomiting that
occur after eating. Blood tests were conducted to test for mal nutrition and to test cells for AGA
and EMA that would indicate celiac disease. James levels of iron, magnesium, vitamin B12 and
folate were all below the normal levels.
Etiology:
Celiac disease is an autoimmune disease, caused by an improper response to gliadin, a
component of gluten (405). Exposure to gliadin results in a T-cell mediated inflammatory
response that damages the intestinal mucosa and is accompanied by white blood cells
infiltrating the mucosa (405). Anti-tTG, EMA, and AGA antibodies are produced in the
inflammatory response and serve as diagnostic indicators for the disease. The AGA and
EMA antibodies are antibodies that cause intestinal inflammation when gliadin is present.
Some typical symptoms of celiac disease, including iron-deficiency anemia, skin rashes,
and malabsorption of magnesium, iron, Vitamin B12, and folate. This is caused from the
mal-absorption of nutrients in the small intestine due to decreased villi surface area and
loss of digestive enzymes.
Diagnostic Measures:
The symptoms that are gastrointestinal symptoms include diarrhea, abdominal pain and
cramping, bloating, and gas production. Other non-gastrointestinal symptoms include
bone and joint pain, muscle cramping, fatigue, peripheral neuropathy, seizures, skin rash,
and mouth ulcerations (405). Patients may also have iron-deficiency anemia (406).that
lead to certain testing for celiac disease include AGA, EMA, and tTG antibodies are
used in serological testing to diagnose celiac disease. Each test is sensitive and specific
for the antibody it measures. The tTG test has a sensitivity of more than 90%. The
Sensitivity is the likelihood of an individual with a disease to be correctly identified
when tested for that disease (37). To have a 90% sensitivity means that 90% of the
individuals with the disease and are tested for it, do have the disease. Specificity is the
likelihood that an individual who does not have a disease will be tested negative (37).
With a 90% sensitivity, and a 95% specificity, this means that the tTG test has a high
accuracy rating in determining who has celiac and who does not. A biopsy of the small
intestine involves removing a portion of the small intestines lining for examination.
During this procedure, a flexible fiber optic or endoscope is inserted through the mouth
or nose and into the upper gastrointestinal tract where a tissue sample is removed
(Eisner). From there, the villous atrophy, crypt hyperplasia, and lymphocytic and plasma

Brooke Bryant
Diet Instruction
Celiac Disease
April 28, 2016
KNH413

cell infiltrate in the lamina propria is documented to determine if the patient has celiac
disease (406).

Treatment:
For severe forms of celiac disease when a patient has an advanced stage of celiac disease
some of the intestine may need to be removed from surgery because it is so damaged it
can no longer function properly. This is normally not very common because of the
symptoms and complications with celiac disease people usually seek medical attention
before it gets to this stage. The medical nutrition therapy that takes place for treatment is
removing gluten from the diet. Clients will be instructed on what foods contain glutens
and about different companies that make gluten free products so that they can still eat
some of their favorite foods but not have to deal with complications of celiac disease.
Some medications such as antibiotics may be given to help clients heal from the damage
that gluten has caused within their GI tract.
Prognosis: Prompt diagnosis will help aid in not having further complications from
gluten. Damage from gluten is cumulative and the earlier that gluten is removed from
the diet the better the health outcome there will be to not have future complications. The
body will quickly return to normal health in most cases after a strict gluten free diet is
put into place (CSA,2016).

Brooke Bryant
Diet Instruction
Celiac Disease
April 28, 2016
KNH413

References
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