Celiac Disease
Celiac Disease Celiac disease is a disease found in the small bowel. This disease does not have a cure. It can only be treated with a strict diet. There are four types of celiac, and all but one can be treated. The disease is a genetically inherited associated with the HL4 locus found on the arm of the chromosome six (schaffner,small-bowel and bacterial overgrowth 2006 pg.99). This disease can cause a lot of problems with a patient if not treated properly. The proper treatment for most individuals is to go on a gluten free diet. A gluten free diet avoids wheat, rye, barley, and sometimes oats. Some symptoms are excessive diarrhea, smelly stools, cramps, and weight loss. The most accurate way to diagnose celiac disease is to do an upper endoscopy on the patient. An endoscopy is a procedure with a tube called a scope and a small camera on the end. The scope goes down the patient’s throat to look at their upper gastric region. A biopsy of jejunal mucosa would be done in the small intestine to send to pathology and determine if the patient has celiac disease. When a patient is on a gluten free diet and their body has not responded to it within two years they call this non-responders. Only five percent of individuals are non-responders. There is also called a refractory sprue this is when someone does not respond to the gluten free diet or has responded and over some time has slipped back and stopped working so the patient has the same symptoms as they did before. There are two types of refractory sprue. Type one is a normal population of intraepithelial lymphocytes. Type two is an premalignant population of intraepithelial lymphocytes based upon clonality analysis of t-cell receptors and immunophenotyping. Type one can never lead to type two, a patient either has one or the other. Type one also has a higher survival rate of a five year study. This disease is a slowly growing disease. Now we find in some areas in the populations that it can be higher than one in
References: Ciclitira, MD, PhD, FRCPJ; Lamont, MD; Grover, MD MPH; Up to date, 2012 www.uptodate.com Greenberger; Blumberg; Burakoff; current diagnosis & treatment;2009; McGraw Hill companies Hauser, MD; pardi, MD; Poterucha MD; mayo clinic gastroenterology and hepatology board review, second edition;2006