Thursday 13 September 2018

CLINICAL MANIFESTATIONS OF CELIAC DISEASE IN CHILDREN


Celiac disease, also known as gluten-sensitive enteropathy is an immune-mediated inflammatory disease of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically predisposed individuals. It differs from food allergies (including wheat allergy), which are mediated by immunoglobulin E (IgE) or immunoglobulin G (IgG). The disorder occurs in 0.5 to 1 percent of the general population. The disorder is commonly referred to as "celiac sprue" or "gluten-sensitive enteropathy" in the United States. It was first described by Samuel Gee in 1887 in a report entitled "On the coeliac affection," although a similar description of a chronic malabsorptive disorder by Aretaeus from Cappadocia (now Turkey) was recorded as far back as the second century AD


The grains that contain the triggering proteins are wheat, barley, and rye. Previously, oats were thought to be harmful but this appears to be from contamination with wheat flour, and most people with celiac disease can tolerate pure oats once they have commenced a gluten-free diet. The small intestinal mucosa improves morphologically when treated with a gluten-free diet and relapses when gluten is reintroduced. The appropriate treatment is a gluten-free diet for life, which results in complete resolution of symptoms for most individuals.


The six key elements in the management of patients with celiac disease can be summarized with the following mnemonic,
Consultation with a skilled dietician
Education about the disease
Lifelong adherence to a gluten-free diet

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