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CELIAC DISEASE

CELIAC DISEASE. WHAT WE WILL COVER. Development of the disease Types of Celiac disease Associated Conditions Symptoms Why is it so hard to diagnose Gluten-free diet Resources for you and your patients. Celiac Isn’t…. a food allergy. Celiac Is…. Curable.

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CELIAC DISEASE

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  1. CELIAC DISEASE

  2. WHAT WE WILL COVER • Development of the disease • Types of Celiac disease • Associated Conditions • Symptoms • Why is it so hard to diagnose • Gluten-free diet • Resources for you and your patients

  3. Celiac Isn’t… a food allergy Celiac Is…. Curable An autoimmune disorder that is characterized by consuming a protein called gluten Treatable

  4. FAST FACTS • 1. One in 133 Americans have celiac disease. • 2. Three million Americans across all races, ages and genders suffer from celiac disease.

  5. FAST FACTS 3. 17% of celiac patients have an immediate family member who also has celiac. 6. $5,000-$12,000 is the average cost of misdiagnosis per person per year, not including lost work time.

  6. Details about Celiac Disease Sometimes called: • Celiac sprue • Non-tropical sprue • Gluten sensitivity • Gluten enteropathy

  7. Celiac Disease • Autoimmune disorder • Often triggered by a stressful event • Damages the villi of the small intestine • Interferes with the absorption of nutrients

  8. Risk Factors • It is a genetic disorder • 17% of celiac patients have an immediate family member with celiac disease • Was thought to be a disease of infants but now often presents between the ages of 10 and 40

  9. How do we test for Celiac? • Serology • IgA anti tissue transglutaminase antibody (IgA tTg) • IgA endomysial antibody (IgA EMA) • IgA antigliadin antibody (IgA AGA) • IgG antigliadin antibody (IgG AGA)

  10. Application of Serology Tests • Individuals with low pretest probability • Individuals with moderate or high probability • Monitoring adherence and response to gluten-free diet

  11. Other Serology Tests • Genetic testing • HLA DQ2 • DQ8 • Those without these genetic markers are very unlikely to have celiac disease

  12. Other Serology Tests • Testing for malabsorption problems • Iron Deficiency Anemia • Folic Acid Deficiency • Vitamin D Deficiency

  13. Problems with Serology testing • Not 100% accurate • Can be falsely negative if patient has started a gluten-free diet

  14. Pathology • Small Bowel Biopsy • Multiple biopsies from second and third portion of duodenum

  15. Problems with Pathology • May not be accurate if patient has started a gluten-free diet • Other causes for Villious atrophy

  16. Types of Celiac Disease • Classical Form • Villous Atrophy • Symptoms of malabsorption • Steatorrhea • Weight loss • Signs of vitamin and nutrient deficiencies • Resolution of mucosal lesions and symptoms when on gluten-free diet

  17. Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later

  18. Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later • Potential Celiac Disease • Negative pathology but positive serology including genetic predisposition and 1st degree relative

  19. Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later • Potential Celiac Disease • Negative pathology but positive serology including genetic predisposition and 1st degree relative • Subclinical Disease • Very mild form and goes widely undetected • Malignancy, nutritional deficiencies, low birth-weight infants, occurrence of autoimmune disorders

  20. Associated Conditions • Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers and other autoimmune diseases. • Frequently associated with Dermatitis Herpetiformis, Down Syndrome, Type 1 Diabetes, Thyroid Disease, Liver Disease, and Atopic Dermatitis

  21. G I Symptoms

  22. Bloating Gas Diarrhea Abdominal Pain Constipation Weight Loss

  23. Non-G I Symptoms

  24. Headaches Irritability Depression Tingling/Numbness

  25. Infertility Growth Thin Bones Joint Pain Dental

  26. Pale Mouth Sores Fatigue Itchy Skin Rash

  27. Why is this hard to Diagnose?

  28. Why is this hard to Diagnose? • 97% of celiacs are undiagnosed or misdiagnosed with other conditions. • 10 years is the average time a person waits to be correctly diagnosed. • $5,000-$12,000 is the average cost of misdiagnosis per person per year, not including lost work time.

  29. Increase Awareness • 500,000 new celiac diagnoses are expected to occur in the next 5 years thanks to efforts to raise public awareness of celiac disease.

  30. Treatment • There are NO pharmaceutical cures for celiac disease. • A 100% gluten-free diet is the only existing treatment for celiac disease.

  31. What is Gluten? • The group of proteins found in wheat, rye, and barley • It’s found in obvious foods like bread, pasta, and cereals • Also found in many “hidden” foods

  32. What is Safe to Eat?

  33. Breads, Grains, Cereals • Rice • Corn • Potato • Tapioca • Soy • Millet • Beans

  34. Vegetables and Fruits • Naturally gluten free • May add pure spices but be careful of spice blends as they often use gluten as a filler

  35. Milk and Dairy • May need to avoid Lactose until intestines heal • Gluten-free, Dairy-free alternatives • Rice, soy, hemp, or nut (almond, hazelnut) • Gluten-free lactase enzyme supplement

  36. Meats and other Proteins • Beef, Chicken, Pork, and Fish are naturally gluten-free unless they have been seasoned or basted (turkey, deli meat, etc.)

  37. Fats, Oils, and Sweets • Olive and Canola oils • Nuts and Pure nut butters • Avoid candies not marked gluten free

  38. Gluten-free Products • The gluten-free marketplace is growing by 28% each year • Find Gluten-free products in specialty health food stores • Now available in many grocery stores including Meijer, Kroger, Walmart, etc • Also available on-line

  39. C • E • L • I • A • C onsultation with skilled dietitian ducation about the disease ifelong adherence to gluten-free diet dentify & treat nutritional deficiencies ccess to an advocacy group ontinuous long-term follow-up

  40. Resources • Physician/Endoscopy office • Web • www.celiac.org • www.gluten.net • www.csaceliacs.org • www.americanceliac.org • www.celiacawareness.org • http://celiacdisease.about.com/forum

  41. Resources • Friends • Library…Cookbooks, etc

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