Coeliac disease

"Coeliac disease is an that primarily affects the , and is caused by the ingestion of in genetically susceptible individuals. in the general population ranges from 0·5% to 2%, with an average of about 1%. The development of the coeliac depends on a complex immune response to gluten proteins, including both and . Clinical presentation of coeliac disease is highly variable and includes classical and non-classical gastrointestinal symptoms, extraintestinal manifestations, and subclinical cases. The disease is associated with a risk of complications, such as and . Diagnosis of coeliac disease requires a positive (IgA anti- 2 and anti- ) and on small-intestinal biopsy. Treatment involves a ; however, owing to the high psychosocial burden of such a diet, research into alternative pharmacological treatments is currently very active."

"Celiac disease has been recognized for centuries (Dowd and 1974) by physicians aware of its major symptoms of and gastrointestinal distress accompanied by a wasting away in adults and a failure to grow in children. The Greek physician (first century A.D.) called the condition coeliac diathesis – coeliac deriving from the Greek word koeliakos, or abdominal cavity. The British physician provided what is generally considered the first modern, detailed description of the condition, which he termed the coeliac affection in deference to Aretaeus, in a lecture presented at in London (Gee 1888). At present, celiac disease (or, especially in Britain, coeliac disease) is the most commonly used term for the condition, although various others may be encountered, including celiac syndrome, celiac sprue, nontropical sprue, and glutensensitive enteropathy."

"Coeliac disease is an characterized by and upon exposure to . It has a global of approximately 1%. Although the can be an effective treatment, this diet is burdensome with practical difficulties and frequent inadvertent gluten exposure. Moreover, there are a variety of potential s and of coeliac disease that might be related to malabsorption and/or chronic immune activation. Overall, individuals with coeliac disease have increased mortality compared with the general population, underscoring the severity of this common disease. and s that have been associated with coeliac disease include poor growth, reproductive complications, kidney and liver diseases, respiratory disease (such as ) and infections (including ). Furthermore, coeliac disease has been linked to other autoimmune disease and psychiatric disease, as well as certain cancers. Data suggest that mucosal healing on a gluten-free diet might protect against some, but not all, of these complications."

"Now was once considered very rare, but in the last probably 10 to 15 years it has become quite common. It's now being diagnosed 20 times as often as it was 30 years ago. Why is this happened? We really don't know. Some people think it might be due to a change in what we're eating or the types of foods we're eating. But really we have no idea why this increase has occurred. This increase parallels other s like and disorders."

"... For reasons that remain largely unexplained, the of celiac disease has increased more than fourfold in the past sixty years. Researchers initially attributed the growing number of cases to greater public awareness and better diagnoses. But neither can fully account for the leap since 1950. Murray and his colleagues at the discovered the increase almost by accident. Murray wanted to examine the long-term effects of undiagnosed celiac disease. To do that, he analyzed s that had been taken from nine thousand recruits between 1948 and 1954. The researchers looked for antibodies to an called ; they are a reliable marker for celiac disease. Murray assumed that one per cent of the soldiers would test positive, matching the current celiac rate. Instead, the team found the in the blood of just two-tenths of one per cent of the soldiers. Then they compared the results with samples taken recently from demographically similar groups of twenty- and seventy-year-old men. In both groups, the s were present in about one per cent of the samples. “That suggested that whatever has happened with celiac disease has happened since 1950,’’ Murray said. “The increase affected young and old people equally.” These results imply that the cause is environmental."

"Clinical characteristics: Celiac disease is a common systemic that can develop in genetically susceptible individuals as a response to dietary . Celiac disease can be associated with gastrointestinal findings (e.g., , , abdominal pain and distention, , , and ) and/or highly variable non-gastrointestinal findings (, , /, other , s, , , , , /, and/or , , , , , autoimmune disorders, and increased risk of cancer). Classical celiac disease, characterized by prominent gastrointestinal symptoms, is less common than non-classical celiac disease, characterized by mild or absent gastrointestinal symptoms. Some individuals with celiac disease have no symptoms despite the presence of immune reactivity to gluten; these individuals are referred to as having silent celiac disease."

"David Kastenberg, MD and Stephanie Winheld, LCGC, (pdf from webinar sponsored by Philadelphia's systems)"