209 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Risk factors There several risk factors associated with celiac disease. These include the follow- ing (Mayo Clinic, 2020a): ● Having a family member with celiac disease or dermatitis herpetiformis. ● Having type 1 diabetes. ● Having Down syndrome or Turner syndrome. ● Having autoimmune thyroid disease. Celiac disease can lead to several com- plications, especially if it is untreated. These complications include the follow- ing (Mayo Clinic, 2020a): ● Malnutrition : Malnutrition occurs if the small intestine is unable to absorb adequate amounts of necessary nutrients. In children, untreated malnutrition can slow growth and shorten stature. ● Weakening of bones : Failure to absorb calcium and vitamin D may lead to osteomalacia (softening of the bone) in children. It may cause loss of bone density, referred to as osteopenia or osteoporosis. ● Infertility and miscarriage : Inability to absorb calcium and vitamin D may cause fertility issues and pregnancy complications. ● Lactose intolerance : The small intestine damage may cause abdominal pain and diarrhea after consuming dairy products that contain lactose. ● Malignancy : If persons affected by celiac disease fail to adhere to a gluten-free diet, they are at higher risk for the development of cancers such as intestinal lymphoma and small intestine malignancy. ● Having microscopic colitis. ● Having Addison’s disease. Complications
● Nervous system issues : Celiac disease is associated with issues such as seizures or peripheral neuropathy. Types of Celiac disease that fail to respond to treatment There are two forms of celiac disease that do not respond to traditional treatment: ● Nonresponsive Celiac disease. Some patients do not respond to what they believe is a gluten-free diet. This problem is typically because patients continue to consume food and drink that contain gluten. A dietary consult is needed to help these types insufficiency, irritable bowel syndrome (IBS), microscopic colitis, or trouble digesting sugars such as lactose, sucrose, and/or fructose (Mayo Clinic, 2020a). ● Refractory Celiac disease. In some rare cases, patients fail to respond to treatment even when adhering to a strict gluten-free diet. This failure is referred to as refractory disease. Those persons who still have signs of patients completely eliminate gluten form their diets. People with nonresponsive celiac disease might have bacterial overgrowth in the small intestine, pancreatic and symptoms for 6 months to 1 year after following a gluten-free diet require further evaluation (Mayo Clinic, 2020a). The exact cause of this form of the disease is not yet known. It is believed that the body’s immune system is involved, particularly T lymphocytes and intraepithelial lymphocytes (IEL), cytokines, and antigens (National Organization for Rare Disorders, 2021).
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