Kristine Kaneichi

Professor Weichhaus
BI-410
9/5/18

Celiac Disease

Celiac disease is an autoimmune disorder that is seriously damaging to the

intestinal walls and inhibits absorption of essential nutrients. This condition affects

1 in 10 Americans. The autoimmune aspect of the disease means that the body is

attacking itself, because it is mistaking healthy cells as bad cells.

In the case of celiac disease it attacks gluten. Gluten is a protein found in

foods such as wheat, barley, and rye, ingesting these foods may be hazardous for

someone with celiac, however gluten is not limited to food products. It can also be

found in everyday items like toothpaste, hair products, and even medicines. Celiac

disease is also believed to be genetic, if there are people in your family with celiac

then your chances of developing the disease increases. Celiac is more common (but

not limited too) in people with type 1 diabetes, microscopic colitis, and thyroid

disease. The environment you live in also plays a role in the development of celiac

disease as well as the changes and variants in your genes.

When the gluten protein enters the body, an enzyme called tissue

transglutaminase changes the gluten protein into a chemical, which in turn damages

the intestine. The villi is the lining in the small intestine that is responsible for

absorbing essential nutrients for your body. After the gluten protein is changed, the

chemical begins to damage and destroy the villi. This prevents the proper

absorption of crucial vitamins and nutrients that your body needs. This can also lead

to the damage of vital organs such as the liver, bone, and brain.
 Celiac disease affects people of all ages; its affect is different for children and

adults. In serious cases, for children this could be damaging to their growth and

development and can lead to malnutrition. The symptoms that are observed and

experienced vary from person to person and adult to child. A patient may have one

or more symptoms of celiac disease. Many do not even know that they have a

disease and go on living with the problem and adjusting to it. Common digestive

symptoms in adults include: abdominal pain, ulcers, intestinal blockage, and

extended tiredness. Overall symptoms are a bit more extensive and once we look

them over we can see why some people may not know that they have celiac disease,

these symptoms include anemia, bone and joint pain, dermatitis, seizures, red

tongue, depression, and anxiety. Lots of these symptoms could be mistaken for

another disease or condition. In children the digestive symptoms can include

diarrhea, gas, vomit, nausea, constipation, stomach pain, and bloating. Overall

symptoms in children include; delayed puberty, slow growth and stunted height,

weight loss, damage in permanent enamel, mood swings, and irritability. Many of

these symptoms can be mistaken for your regular child going through puberty. The

symptoms for celiac disease are extremely varied and dependent on a number of

factors; how long the patient was breastfed in their infant stage, the patients current

age, how much gluten the patient consumes, and when the patient first began to

consume gluten. All of these factors determine the types of symptoms a patient may

have and when they may start to see symptoms. There are also those patients who

will never see symptoms and the problem just develops over time.
 With all these varied symptoms and specified conditions how does a patient

ever know if they have celiac disease? Today there a number of tests doctors use to

determine if a patient has celiac disease. The most common test is a simple blood

test. This is actually just the initial step, the blood test is called serological blood test

and doctors will look for antibodies in the patient’s blood work and concentrate on

the bodies’ immune system. Unfortunately there are still so many implications with

celiac disease that even with a positive blood test many doctors will still recommend

a colonoscopy or endoscopy. With an endoscopy test the doctor will take a biopsy

obtained from the duodenum, which is the first area of the small intestine, they may

also obtain samples from the jejunum, which is the area right after the duodenum

and perform biopsies on these samples. Typically 4-8 samples are taken. These

biopsies can show the density of white blood cells found in the immune system, if

there is shrinking in the villi, and structural abnormalities in the epithelial cells.

Other tests include an iron deficiency test for anemia, folic acid deficiency,

thyroid function test, hypocalcaemia test, or a reduced bone density test. One test

that doctors recommend, if there is still no clear reading as to if the patient has

celiac disease or not, is called a gluten withdrawal. To perform this test, the patient

must consume and ingest gluten then monitor the after affect. This test is not an

option for children under 5 years old. Fortunately this test is usually not necessary

to perform.

Once one or a variety of these tests are performed doctors use a scale called

the Marsh Classification. This classification system tells us the level of damage in the

body. The scale now ranges from 1-3, with 3 indicating celiac disease. Before it
ranged from 1-4 and has since then been simplified. It is based on the biopsies taken

and looking at the intra-epithelial lymphocytes out of 100 enterocytes from both the

duodenum and jejunum. Doctor’s chart the found information and determine what

level the patient falls on the Marsh Classification scale.

Unfortunately, as with all autoimmune diseases, there is no cure for celiac

disease. Once the patient finds out they have this disease they must learn how to live

with it. Right now the only “cure” for celiac disease is the gluten-free diet and

lifestyle where they will avoid consuming or using anything containing gluten. While

this is not completely unreasonable and very achievable, for some patients it is a

real challenge. This causes a true dietary restriction. Luckily today gluten allergies

are being made aware of in society. Lots of restaurants offer gluten free options and

have special ways in preparing food so that no traces of gluten will be in the dish.

There are also many articles and cookbooks, which suggest how to start and stay on

gluten-free diet. Once diagnosed with celiac disease it is important to read the

ingredient lists in all the products that are used. As mentioned above gluten is not

only found in food but in everyday items as well.

Fortunately, in today’s time and the way science and technology has been

growing, there are new methods for diagnosis and treatment of celiac being studied.

One study added lactobacilli to sourdough bread to fermentation. By doing this they

were able to lyse or cut out the gluten-peptide and decrease immunotoxicity. A

mixture of fermented wheat flour, oat millet, and buckwheat allowed the bread to

keep its baking characteristics. Researchers went on to feed this bread to patients

with celiac disease over a period of 2 days. This was not enough to come up with a
conclusive conclusion; so another study was done over a 60 day period. After and

during the 60 day period, serological blood tests were taken from each patient to

monitor the affect of the gluten in the patient’s bodies and immune system. Based on

the blood test the gluten that was consumed by the patient with celiac disease did

not have damaging affects. This type of experiment tests the working effect of the

hydrolysis of toxic gliadin peptide, in other words cutting out the peptide that

affects the gluten.

Another study for the treatment of celiac disease is a vaccine. If scientist

were able to pull this off it would be beneficial for not only people with celiac

disease but it would also open the door for a vaccine for other autoimmune diseases.

The specific vaccine they are studying is to restore immune tolerance toward gluten.

Scientists mapped t-cells to determine gliadin reactive epitopes, which is found in

90% of patients with celiac disease. The vaccine contains a mixture of alpha and w-

gliadins and B-horedin. So far this has only been tested in mice and still needs more

work.

Celiac disease is one of those conditions that is extremely difficult to

diagnose and treat. Diagnosis can be extensive and invading, even if you come out

with a positive serological blood test you would still need the endoscopy to obtain

the samples to perform the biopsies. Then once diagnosed, there is no real

treatment; it is more of a lifestyle change than it is a treatment. It can also create a

huge inconvenience in your everyday life. You can take vitamins and minerals to

make up for the mal-absorption but that would not do anything for the vital organs

that are being damaged. If you see or experience any of the many symptoms
mentioned here, trying the gluten free diet, before even going for the tests, could be

a way to determine if you have celiac disease or at least a gluten intolerance. It is not

a sure shot conclusive method in knowing you have the disease or not but it is much

less invasive. The test will however, confirm how extensive your lifestyle change

needs to be.
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