Disorders of the Gastrointestinal System, 2nd Edition
51
Celiac disease Also referred to as gluten-sensitive en- teropathy and celiac sprue, celiac disease damages the small intestine. It is charac- terized by an inability to properly absorb nutrients and intolerance to gluten, a pro- tein found in wheat, wheat products, rye, and barley (Goebel, 2019). Gluten can be present in many food types and may also be found in everyday items such as vitamins, lip balms, dressings and sauc- es, and some medicines (Celiac Disease Foundation [CDF], 2022. Celiac disease is a twofold disease. It is a disease of mal- absorption as well as an immune reaction to gluten. When gluten is ingested, it trig- gers an immune response that injures the villi in the upper portion of the small intes- tine. This reduces intestinal surface area and results in the malabsorption of most nutrients (Goebel, 2019). Under normal conditions, villi allow the absorption of nutrients from food into the bloodstream. If villi are not healthy, nutrients cannot be absorbed. This causes the patient to be- come malnourished, no matter how much food is ingested (Goebel, 2019). An immune response to gluten caus- es celiac disease. Development of the disease can have genetic or environ- mental components, and several genes have been identified and linked to the disease. There is a strong genetic asso- ciation among persons who have the dis- ease. People with a first-degree relative (parent, sibling, child) with celiac disease have a 30%–40% chance of developing the disease (Goebel, 2019). However, re- cent research has shown it is also more common in people with other genetic disorders, such as Down’s syndrome (Hill, 2021).
EVIDENCE-BASED PRACTICE ALERT Celiac disease was previous identi- fied most often in those with Cauca - sian and Western European ancestry. However, recent studies have shown that this may no longer be true. Inci- dence is increasing in Northern Africa, the Middle East, India, and Northern China. In fact, the incidence of this disease may be grossly underestimat- ed in general, as recent studies have also shown that celiac disease is pres- ent in asymptomatic patients seven times more than those that present with symptoms (Schuppan & Dietrich, 2022). Celiac disease is found in people worldwide. About 1% of the U.S. popu- lation has celiac disease, affecting one in every 100 people (Goebel, 2019). Celiac disease affects females more often than males (Goebel, 2019). It is also more prev- alent in people with other autoimmune diseases such as type I diabetes mellitus, thyroid diseases, Addison’s disease, rheu- matoid arthritis, and Sjogren’s syndrome (Schuppan & Dietrich, 2022). Other con - ditions associated with celiac disease in- clude anemia, infertility, and osteoporosis (Goebel, 2019). Complications associated with celiac disease include (Goebel, 2019): ● Anemia secondary to malabsorption. ● Syncope, angina, or heart failure because of anemia. ● Bleeding disorders because of vitamin K deficiency. ● Intestinal lymphoma or adenocarcinoma.
Powered by FlippingBook