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Celiac Disease PowerPoint Presentation

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This medical PowerPoint presentation talks about celiac disease, an autoimmune disorder that affects the small intestine. It is triggered by consuming gluten, a protein found in wheat, barley, and rye. In people with celiac disease, gluten causes an immune reaction that damages the lining of the small intestine, leading to malabsorption of nutrients.

The symptoms of celiac disease can vary widely and may include diarrhea, abdominal pain, bloating, fatigue, weight loss, and anemia. Because these symptoms can also be caused by other conditions, celiac disease can be difficult to diagnose. A blood test to detect specific antibodies and a biopsy of the small intestine are usually necessary for a definitive diagnosis.

The treatment for celiac disease is a strict gluten-free diet, which means avoiding all foods that contain wheat, barley, and rye. This can be challenging, as gluten is found in many common foods, such as bread, pasta, and cereal. However, with proper education and support, people with celiac disease can successfully manage their condition and live a healthy, active life.

Tags : Celiac Disease, autoimmune disorder, small intestine, Gastroenterology, Gastroenterology PowerPoint presentation

Published on : May 02, 2023 | Views : 1872 | Downloads : 4

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Slide 1-

1 Definition Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in symptomatic subjects with gastrointestinal and non-gastrointestinal symptoms, and in some asymptomatic individuals, including subjects affected by: - Type 1 diabetes - Williams syndrome - Down syndrome - Selective IgA deficiency Turner syndrome - First degree relatives of individuals with celiac disease
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2 Clinical Manifestations Gastrointestinal (“classical”) Non-gastrointestinal ( “atypical”) Asymptomatic In addition, Celiac Disease may be associated with other conditions, and mostly with: Autoimmune disorders Some syndromes
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3 The Celiac Iceberg Symptomatic Celiac Disease Silent Celiac Disease Latent Celiac Disease Genetic susceptibility: - DQ2, DQ8 Positive serology Manifest mucosal lesion Normal Mucosa
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4 Gastrointestinal Manifestations(“Classic”) Most common age of presentation: 6-24 months Chronic or recurrent diarrhea Abdominal distension Anorexia Failure to thrive or weight loss Rarely: Celiac crisis Abdominal pain Vomiting Constipation Irritability
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5 Typical Celiac Disease
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6 Non Gastrointestinal Manifestations Dermatitis Herpetiformis Dental enamel hypoplasia of permanent teeth Osteopenia/Osteoporosis Short Stature Delayed Puberty Iron-deficient anemia resistant to oral Fe Hepatitis Arthritis Epilepsy with occipital calcifications Most common age of presentation: older child to adult Listed in descending order of strength of evidence
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7 Silent: No or minimal symptoms, “damaged” mucosa and positive serology Identified by screening asymptomatic individuals from groups at risk such: First degree relatives Down syndrome patients Type 1 diabetes patients, etc. 3 – Asymptomatic Silent Latent
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8 Latent: No symptoms, normal mucosa May show positive serology. Identified by following in time asymptomatic individuals previously identified at screening from groups at risk. These individuals, given the “right” circumstances, will develop at some point in time mucosal changes (± symptoms) 3 – Asymptomatic Silent Latent
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9 Associated Conditions Relatives IDDM Thyroiditis Down syndrome 0 4 8 12 16 20 percentage General Population
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10 Relatives Healthy population: 1:133 1st degree relatives: 1:18 to 1:22 2nd degree relatives: 1:24 to 1:39 Fasano, et al, Arch of Intern Med, Volume 163: 286-292, 2003
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11 Major Complications of Celiac Disease Short stature Dermatitis herpetiformis Dental enamel hypoplasia Recurrent stomatitis Fertility problems Osteoporosis Gluten ataxia and other neurological disturbances Refractory celiac disease and related disorders Intestinal lymphoma
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12 Epidemiology The “old” Celiac Disease Epidemiology: A rare disorder typical of infancy Wide incidence fluctuates in space (1/400 Ireland to 1/10000 Denmark) and in time A disease of essentially European origin
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13 “Mines” of Celiac Disease Were Found Among: Relatives Patients with short stature, anaemia, fatigue, hypertransaminasemia Associated diseases autommune disorders, Down s, IgA deficiency, neuropathies, osteoporosis, infertility “Healthy” groups blood donors, students, general population
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14 Celiac Disease Epidemiological Study in USA Prevalence 1:39 Prevalence 1:22 Population screened 13145 Positive 31 Negative 4095 Positive 81 Negative 3155 Positive 205 Negative 4303 Positive 33 Negative 1242 Prevalence 1:40 Symptomatic subjects 3236 1st degree relatives 4508 2nd degree relatives 1275 Healthy Individuals 4126 Risk Groups 9019 Prevalence 1:133 Projected number of celiacs in the U.S.A.: 2,115,954 Actual number of known celiacs in the U.S.A.: 40,000 For each known celiac there are 53 undiagnosed patients. A. Fasano et al., Arch Int Med 2003;163:286-292.
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15 Celiac Disease Prevalence Data Fasano & Catassi, Gastroenterology 2001; 120:636‑651. *based on classical, clinical presentation
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16 Celiac Disease Icebergs 0 2 4 6 8 10 Overall Diagnosed Ireland Italy Netherlands Sweden USA
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17 The Global Village of Celiac Disease In many areas of the world Celiac Disease is one of the commonest, lifelong disorders affecting around 1% of the general population. Most cases escape diagnosis and are exposed to the risk of complications. Active Celiac Disease case-finding is needed but mass screening should be considered. The impact of Celiac Disease in the developing world needs further evaluation.
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18 Diagnostic principles Confirm diagnosis before treating Diagnosis of Celiac Disease mandates a strict gluten-free diet for life following the diet is not easy QOL implications Failure to treat has potential long term adverse health consequences increased morbidity and mortality Diagnosis
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19 Serological Tests Role of serological tests: Identify symptomatic individuals who need a biopsy Screening of asymptomatic “at risk” individuals Supportive evidence for the diagnosis Monitoring dietary compliance
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20 Serological Tests Antigliadin antibodies (AGA) Antiendomysial antibodies (EMA) Anti tissue transglutaminase antibodies (TTG) first generation (guinea pig protein) second generation (human recombinant) HLA typing
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21 Serological Test Comparison Farrell RJ, and Kelly CP. Am J Gastroenterol 2001;96:3237-46. Sensitivity % Specificity % AGA-IgG 69 – 85 73 – 90 AGA-IgA 75 – 90 82 – 95 EMA (IgA) 85 – 98 97 – 100 TTG (IgA) 90 – 98 94 – 97
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22 Histological Features Normal 0 Infiltrative 1 Hyperplastic 2 Partial atrophy 3a Subtotal atrophy 3b Total atrophy 3c Horvath K. Recent Advances in Pediatrics, 2002.
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23 Pathogenesis Celiac disease Genetics Gluten Necessary Causes Gender Infant feeding Infections Others Risk Factors Pathogenesis ?
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24 5 Submucosa T B AGA, EMA, atTG Cytokines (IL2, IL15) Tk P TTG 3 4 7 APC 2 1 6b 6a 8 2a 2b 8
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25 Treatment Only treatment for celiac disease is a gluten-free diet (GFD) Strict, lifelong diet Avoid: Wheat Rye Barley
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26 Sources of Gluten OBVIOUS SOURCES Bread Bagels Cakes Cereal Cookies Pasta / noodles Pastries / pies Rolls
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27 Barriers to Compliance Ability to manage emotions – depression, anxiety Ability to resist temptation – exercising restraint Feelings of deprivation Fear generated by inaccurate information
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28 Factors that Improve Adherence Internal Adherence Factors Include: Knowledge about the gluten-free diet Understanding the risk factors and serious complications can occur to the patient Ability to break down big changes into smaller steps Ability to simplify or make behavior routine Ability to reinforce positive changes internally Positive coping skills Ability to recognize and manage mental health issues Trust in physicians and dietitians
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29 6 Submucosa T B AGA, EMA, aTTG Cytokines (IL15) Tk P 3 TTG 4 5 7 1 APC 33-mer 2 8