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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