Introduction
The celiac disease attacks the small intestine and damages the villi. It is an autoimmune disease. Patients with celiac disease have triggered immune responses when they intake any food that contains gluten. Patients who suffer from Type I Diabetes, rheumatoid arthritis, scleroderma, psoriasis, autoimmune hepatitis, down syndrome, or any other autoimmune diseases, are at high risk of getting celiac disease. Celiac Disease can affect both adults and children. Through this blog, we will be focusing on the diagnosis and management of Celiac Disease. To know about the risk actors and symptoms of celiac disease, do read our previous bog by visiting the following link (Click here to read)
Diagnosis of Celiac Disease
It is impossible to diagnose celiac disease only on clinical symptoms since the clinical signs are diverse. Thus a physician needs to carry out diagnostic tests to confirm the disease. Initially, the physician will conduct blood tests to check if the clinical symptoms are related to celiac disease. The two blood tests are:
- Serology Testing: Serology tests help to determine the presence of antibodies in the blood. An increase in immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies indicates a gluten-induced immunological response. In addition, TG2 (Transglutaminase Type 2) plays a role in celiac disease pathogenesis by altering gluten peptides to convert glutamine residues to glutamic acid. Therefore, ELISA-based tests using recombinant human TG2 as antigen are predominantly used to detect antibodies to the gluten subcomponent called gliadin.
- Genetic Testing: Genetic testing identifies any chromosomal mutation of HLA-DQ2 and HLA-DQ8 genes, where HLA stands for Human Leukocyte Antigens. Genetic testing can also be called an HLA Typing assessment.
Diagnosing Celiac Disease if the patient is already on a gluten-free diet
When a patient goes on a gluten-free diet after self-examining the disease and then seeks medical help for a correct diagnosis and treatment, it can be challenging to diagnose celiac disease. Patients are thus advised not to go for a gluten-free diet by self-examining the clinical symptoms. However, if some instances arise, the physicians diagnose Celiac Disease by carrying out an oral gluten challenge test. The test is carried out for three days. After three days, most celiac patients appear to have T cells in their peripheral blood, specifically for deamidated gluten peptides. Techniques like ELISPOT assay or HLA-DQ2 – gliadin peptide tetramers staining are used to detect these T cells. More studies are still under research on these two techniques to get more efficient results.
If the above tests show positive results for Celiac disease, the physician finally carries out one of the two tests to confirm their diagnosis. These tests are also called intestinal biopsies. It includes the following tests:
- Endoscopy
Endoscopy consists of a long tube with a small camera at one end, passed down the throat to reach the small intestine. The physician uses it to check the inner view of the small intestine without the patient undergoing surgery. In addition, the endoscopy takes a small sample of tissue from the intestine to analyze the damage done by Celiac disease on the villi. - Capsule Endoscopy
Capsule Endoscopy takes a picture of the entire small intestine. The camera is present inside a capsule (like the size of vitamin capsules). First, the patient swallows the capsules, and then the capsule travels through the digestive tract taking pictures of the small intestine.
Management of Celiac Disease
At present, there is no permanent cure or treatment for Celiac disease. Clinical Research and trials are in progress to find a cure for Celiac Disease. A strict, lifelong gluten-free diet can only manage celiac disease.
Patients have to refrain from taking any food items containing gluten (which means any food items made from wheat and wheat flour). Thus, food items like wheat, barley, malt, semolina, bulgur, rye, graham flour, ice cream, candies, yogurt, pastries, and other things that contain gluten should be avoided by the patient. In addition, patients should check the food ingredients of processed foods before purchasing. A gluten-free diet reduces inflammation, and eventually, the patient feels better.
Patients should visit a nutritionist or dietitian after proper diagnosis by a registered physician. Patients should follow the diet chart suggested by the nutritionist for appropriate management of Celiac Disease. Following a gluten-free diet according to the advice of a dietitian/nutritionist gives positive results within few weeks.
Physicians also recommend vitamins and supplements among Celiac disease patients who suffer from severe anemia or nutritional deficiencies. These vitamins and supplements are given as pills or injections (in case the patient has trouble absorbing vitamins). The vitamins and supplements include:
- Copper
- Folate
- Iron
- Vitamin B-12
- Vitamin D
- Vitamin K
- Zinc
However, certain medications in the form of tablets and capsules contain wheat starch as a binding agent. Therefore, patients should follow the physician or pharmacist’s advice before taking any medication.
References
- Mayo Clinic. 2021. Celiac disease – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220> [Accessed 12 August 2021].
- WebMD. 2021. Celiac Disease. [online] Available at: <https://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease> [Accessed 12 August 2021].
- Sollid, Ludvig & Lundin, Knut. (2009). Diagnosis and treatment of celiac disease. Mucosal immunology. 2. 3-7. 10.1038/mi.2008.74.
