Disorders of the Gastrointestinal System, 2nd Edition
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A wide variety of signs and symptoms are associated with celiac disease, as it af- fects people in different ways because of the amount of damage to the small intes- tine, age, and the length of time the pa- tient has had symptoms before diagnosis and treatment (Goebel, 2019; Schuppan & Dietrich, 2022). Common signs and symptoms of celiac disease include: ● GI effects : Damage to the small intestine may cause cramping, recurrent diarrhea, constipation, abdominal distention and bloating, weakness, and an increase in appetite without weight gain (Goebel, 2019). ● Hematologic effects : Anemia because of malabsorption of folate, iron, and vitamin B12 (Schuppen & Dietrich, 2022). ● Malabsorption effects : Loss of calories, fat-soluble vitamins (vitamins A, D, E, K), calcium, minerals, and electrolytes; also malabsorption of fat, carbohydrates, and protein (Goebel, 2019). ● Musculoskeletal effects : Osteomalacia, osteoporosis, tetany, muscle pain, and bone pain because of calcium loss and vitamin D deficiency (Goebel, 2019); growth may also be stunted in children with the disease (Hill, 2021). ● Neurologic effects : Paresthesia, seizures, or peripheral neuropathy (Schuppen & Dietrich, 2022). ● Skin effects : Dry skin, eczema, psoriasis, dermatitis, brittle nails; dermatitis herpetiformis is sometimes observed in patients with celiac disease and is characterized as very itchy red bumps with vesicle formation (Adams, 2019); sores inside the mouth
are also common in celiac disease patients (Colgate, 2022). ● Endocrine effects: Amenorrhea, hypometabolism, or adrenocortical insufficiency (Goebel, 2019). ● Psychosocial effects : Irritability, lethargy, chronic fatigue, or mood changes (CDF, 2022). Diagnostic tests used in celiac disease include the following: ● Esophagogastroduodenoscopy : During this test, tissue specimens are obtained for biopsy. Histologic changes observed include a mosaic- like pattern of alternating flat and bumpy areas; a nearly total absence of villi; and an irregular, blunt, unorganized network of blood vessels confirming the diagnosis (Kelly, 2022). ● Barium swallow: This can show dilation of the intestine, changes in the mucosa, and/or other changes to the intestinal tissue (Goebel, 2019). ● Blood studies : The tTG-IgA and EMA- IgA tests that assess autoantibodies and IgA deficiencies can be used for most patients. However, additional testing and biopsy may be needed to confirm a diagnosis of celiac disease. Additional testing for the anti-DGP IgA antibody and genetic testing for DQ2 and DQ8 genes may also be warranted, especially if a genetic link is suspected (Kelly, 2022). ● Malnutrition may be present because of serum mineral, vitamin, and electrolyte values (Goebel, 2019). The only current treatment for celiac disease is implementing a completely gluten-free diet for the remainder of the patient’s life (Goebel, 2019). This involves eliminating wheat, barley, rye, and oats from the diet and foods that contain these products. Patients usually notice signs of
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