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Coeliac Disease 2
TABLE OF CONTENTS:
Introduction………………………………………………………………………………… 1
Bibliography………………………………………………………………………………….16
Introduction:
Coeliac Disease 3
IT IS A SILENT PLAGUE. Some of those who have the disease suffer from no
symptoms at all—meaning the disease for most of the time is asymptomatic; while there
are some clinicians say that there are about 200 known signs and symptoms of this
disease (University of Chicago Celiac Disease Center, n. d., p. 1). If you will look at the
profile of those who have already contracted it, you will find that the ‘victims’ vary on
In the past decades, it is estimated that around two to three million Americans
and about three million people in Europe. All over the world, there are about 20 million
people who are suffering with the disease that affects not only their well-being but also
their health. And according to a medical expert from Spain the disease is rapidly
spreading in almost all continents in the world (Rodrigo, 2006, p. 6585). You might have
been asking, what is this disease that we are talking about? It’s the Coeliac Disease
(CD).
U.S. Department of Health and Human Services defines CD as a “digestive disease that
damages the small intestine and interferes with the absorption of nutrients from food”
(2008, p. 1).
Loftus and Murray, both gastroenterologists and hepatologists from the Mayo
irritation or swelling of the fingerlike lining of small intestines called the villi (2010., p. 1).
These fingerlike lining in the small bowel (another term for the small intestine) function
Coeliac Disease 4
2010).
Photo of healthy
In a lecture delivered by Samuel Gee in 1887, it was the first time that the
disease has been mentioned (Dewar & Ciclitira, 2004 p. 23). Gee, cites Dewar &
Ciclitira (2004) said that the disease is being characterized by lassitude, failure to thrive
It was Paulley who has provided the medical community the accurate picture or
description of a coeliac lesion in 1954, for it was he who has carefully examined the
biopsies taken at lapatory. (Dewar & Ciclitira, 2004 p. 23). On the other hand, it was
Marsh who had proposed to classify different types of celiac lesions as he is the one
who has dug into the subject more deeply, as he examined, in 1992, relatively a huge
number of samples of tissues taken from the patients (Dewar & Ciclitra, 2004, p. 23).
Central de Asturias, in Asturias, Spain had said that CD is autoimmune disease (2006 p.
8565). When the disease is called autoimmune, it means that the person’s own immune
system attacks some healthy tissues thus causing the disorder (MedicineNet.com,
2010). Those people who suffer from autoimmune diseases usually have “unusual”
antibodies circulating in their blood that target their own body tissues (MedicineNet.com,
2010).
Most of the detected cases of CD involve patients who have family members who
are also suffering with the disease (Loftus and Murray, 2010., p. 1), thus making the
disease genetic (Mäki et al., 2003 p. 2517; University of Chicago Celiac Disease
must also have DQ2 heterodimer comprised of DQB1*02 and DQA1*05 (as found in 95
per cent of the patients diagnosed with CD). Nevertheless, five per cent of the people
DQA1*03. He also explained that a small percentage or a few number of people who
Likewise, gene dosage also affects CD susceptibility, says Kaskoff (2004, p. 20).
“The DR17 homozygous individuals who carry DQB1*02 and DQA1*05 in cis on both
chromosomes have a greater risk of [having the] disease,” Kaskoff (2004) said.
Coeliac Disease 6
Moreover, contrary to the popular belief that CD is just a pure digestive alteration,
says Rodrigo, CD is a protean systemic disease (2006 p. 8565). Gluten, a certain type
of protein found in wheat, barley and rye was said to be “triggering device” for the
disease to “launch an offence” against the sensitive lining of the small bowel (Mäki et
Lemkin further explained that eating food containing gliadin pulls the trigger for
the T-cells to attack the lining of the small bowel, thus damaging that sensitive lining of
the intestine (p. 1). Some gastroenterologists said that oats can be “fatal” to those who
are suffering from the disease. Meanwhile the NDDIC (2008) said that:
“When people with celiac disease eat foods or use products containing gluten,
allow nutrients from food to be absorbed through the walls of the small intestine
Photo of healthy villi (right), against the damaged by the CD (Loftus and Murray, n. d.)
THE NDDIC (2008) stated that celiac disease is also more common among
people with other genetic disorders including Down syndrome and Turner syndrome, a
condition that affects girls’ development (p. 3). In addition to this, people with the
disease are also detected to have other autoimmune disorders such as rheumatoid
arthritis and type-1 diabetes (Ward, 2006 p. 1). Moreover, the NDDIC also stated that
CD is also common to persons with Addison’s disease (a condition in which the glands
that produce critical hormones are damaged); Sjögren’s syndrome, a condition in which
the glands that produce tears and saliva are destroyed; and those who have
Finland admitted that there is a serious concern over the under-diagnosis of the disease
Coeliac Disease 8
for it is detrimental to the health of the patient, especially for growing children, despite
the fact that the disease is well-known in the country (Mäki et al., 2003 p. 2518).
What is more alarming is that, if the disease remains undetected, it will cause
more harm to the patient (Case, as cited in Ward, 2006, p. 1) as CD is usually linked to
Mäki et al’s view about the disease is being supported by the study made by
Rodrigo (2006) that states in the past decade, CD is treated as a rare disease being
[as] one of the of the most commonly known genetic diseases, with a mean prevalence
of one to two per cent (1% - 2%) in the general (pp. 6585 – 6586).
Based on the latest statistics, as mentioned earlier in the prefatory part of this
essay, it is estimated that 20 million people, globally are infected with the disease. In the
U.S., about 1:133 Americans are affected by the disease and prevalence of the disease
between two people with first degree of consanguinity is 1:22 (Lemkin, 2003 p. 1). This
means that in the U.S. alone, there are about three million people who suffer from this
If experts are to include all the diseases that have something to do with gluten,
the prevalence would shoot up, between five per cent of the entire American population
Moreover, in European countries, there are about three (3) million people, who
are affected by the disease. In Asia, it is suspected that there about 10 million Chinese
are suspected of having this lifelong disease, which is equivalent to 10 per cent of the
Coeliac Disease 9
relatively high. It is said that 26 to 49 per cent of children who are suffering from chronic
Detection is hard, says Pietzak (as cited in Ward, 2006 p. 1) says that the it
The NDDIC revealed that symptoms of the disease vary from person to person
(2008 p. 2). However, in children the common symptoms are these: abdominal bloating
and pain; chronic diarrhea; vomiting; constipation; pale, foul-smelling, or fatty stool; and
weight loss (NDDIC, 2008 p. 2). Due to malabsorption of nutrients from food, irritability
The NDDIC, meanwhile said, that some adults may not have a digestive
manifestation or symptoms of the disease, the State agency enumerated some signs
that may signal the patient to undergone testing in order to find if he or she is suffering
• fatigue
• arthritis
• depression or anxiety
Coeliac Disease 10
• seizures
Although some people might not suffer from any of these symptoms, there are still
dangers they might catch the complications associated with CD. That is why, experts
Even the U.S. Health Department admits that detecting the disease is difficult as
symptoms of some digestive diseases are similar with the known symptoms of CD
intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long
There are two methods to diagnose if the patient has CD: one is through serum
patients
In the former, the doctors will test the blood of the patient if there are indications
antibodies (EMA), the antibodies that attacks healthy tissues inside the body.
Hill (2004) said that serological tests are very important for the identification of
patients who need intestinal biopsy in order to diagnose correctly if the patient has CD.
Hill said that the most common types of test being administered commercial laboratories
in order to diagnose a patient who is suspected of having CD are IgG- and IgA-based
IgA tissue transglutaminase antibody (TTG-IgA), and IgA antireticulin antibody (ARA-
However, there are some questions on the sensitivity and specificity of these
tests as some scientists had tested this only in research, and not, in the clinical setting
and the accuracy of such tests might not that accurate as some may presumed (Hill
2004, p. 27).
Hill (2004) had identified three (3) reasons of why some of the tests might not be
study populations in the research settings usually differ from those in clinical practice;
and (3) the definition of “gold standard” for diagnosing CD is quite problematic (p. 26).
In order to support this claim, Hill (2004) had presented a table that presents the
high variability of the sensitivity and specificity of different tests administered in adults
and in children:
Coeliac Disease 12
From the aforementioned, comparative results, Hill (2004) had drawn the
following conclusion(s):
1. TTG-IgA (human recombinant) and EMA-IgA are the most sensitive and
intestinal biopsy for CD diagnosis. Their accuracy in clinical practice may not
2. Serological tests may be less reliable in very young children. AGA tests are
using a panel of tests incorporating AGA, EMA, and TTG antibodies over a
Rostom, on the other hand, in his study about the sensitivity and specificity of different
patients that poses the possibility of the subject of having CD, presented at the NIH
overall, the results suggest that EMA and tTG antibodies demonstrate extremely high
Based on his review, Rostom (2004) had found out that in the studied
populations, testing for the IgA-EMA and IgA-tTG have sensitivities and
the pooled specificity of EMA was 100 percent in adults using either EMA-ME
or EMA-HU; that in studies of children, the specificity of EMA using these two
values; that in adults, the pooled specificity of tTG-GP and tTGHR were 95
overlapping CIs; and that among the three studies in adults, and four studies
in children that assessed both EMA and tTG, the specificities were nearly
On the other hand, Eisentbarth (2004) since most of the cases of CD are genetic,
it is good for the babies to be subjected in the newborn screening process in order to
He also said that newborn screening can also prevent the repeated testing to
useful, given the prevalence of celiac disease and the potential for altering
relatively simple factors such as the timing of introduction of gliadin (p. 39).
If the blood tests had already shown the indicators that someone might
have CD, the doctor might recommend that the patient must undergo
intestinal biopsy or small bowel biopsy (SBB). This method is done by getting
some tissues from the small bowel to check the extent of the damage that
manifestations of CD, in some cases, are very subtle and can only affect
older children and some adults (Rewers, 2004 p. 45). On the other hand,
some of the patients poorly accept the method, especially to those who
As the diagnosis shows that the patient is positive with CD, the
The NDDIC said the only way for the CD not to advance rapidly and
cancer, to develop is for the person is to go to strictly (GFD) (p. 9). This
means that the patient can eat any food, as long as it is gluten-free.
However, there are also precautions in food suspect to contain gluten such
as bouillon cubes, brown rice, syrup candy, chips/potato chips cold cuts, hot
dogs, salami, sausage communion wafers, French fries gravy imitation fish,
matzo, rice mixes, sauces, seasoned tortilla chips, self-basting turkey soups,
in order to detect CD much faster and make the person who has it, can live
managing the disease more easily (NDDIC 2008, p. 9). The National Institute
Health and Human Services are is now evaluating some drugs in order to
prevent the attack and the advancement of the disease (NDDIC 2008, p. 9).
education about the disease and to prevent the CD-associated diseases that
the damage of the small intestines’ lining by protein called gluten. In the
past decades, the CD is considered as a rare disease but the rapid spread of
this autoimmune, lifelong disease had caused alarm to the scientific and
medical communities, that they have arrived in the conclusion that the
presence of the disease are the serological testing and intestinal (small
bowel) biopsy. The former tests the patients in the presence of the gene HLA
person to develop CD and the DQ2 heterodimer comprised of DQB1*02 and DQA1*05
(as found in 95 per cent of the patients diagnosed with CD). The latter is invasive, for it
needed to obtain portions of the small intestine’s tissue in order to assess the damage.
Bibliography:
Dewar D. and Ciclitira, P. J. (2004). The Pathology of Celiac Disease. In: U.S.
Health.
Coeliac Disease 17
Online: <http://www.britannica.com/EBchecked/topic/629261/villus>
Hill, I. (2004) What Are the Sensitivity and Specificity of Serological Tests for
Health
<http://www.pioneernutritional.com/literature/health_ed_library.html>
<http://www.acg.gi.org/patients/gihealth/pdf/celiac.pdf> [Accessed 24
September 2010]
<http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm>
Prevalence,
pp. 6585-6586
Rostom, A. (2004) Serological Testing for Celiac Disease. In: U.S. Institutes on
Ward, E. 2005. Gluten Intolerance: Against the Grain (Do wheat products
disorders/celiac-disease/features/gluten-intolerance-against-grain>