Mot common cause of
diarrhoea in the western
What is it?
'gluten sensitive enteropathy'
Broken down into gliadin peptides
Prolamin (protin found in gluten)
Autoimmune response --> GLIADIN
NORMAL PHYSIOLOGY --> gliaidin should be broken down when it is in the small bowel by IgA, which mark it for breakdown by the immune system. HOWEVER, in coeliacs, there is an increased expression of the transferrin receptor, allowing gliadin to cross the enterocyte barrier -> creates an immune response.
Genes that are found in patients with coeliac disease, that code for specific MHC receptors on macrophages that bind to gliadin fragments, and thus create an immune response to gliadin.
T helper cells (CD4+) bind to the gliadin fragments expressed on the macrophages and cause a subsequent inflammatory response - secrete inflammatory cytokines that can directly destroy cells in the intestine.
B cells also produce antibodies against trangultaminases (enzymes that break down the gliadin into fragments), and also against gliadin -- good for making a diagnosis.
Killer T cells are drawn to the area, kill cells that have been afffected by the inflammation.
Inflammation and cellular destruction
Results from the Killer T cells (CD8) and from inflammatory cytokines released by T helper cells (CDT4+), in response to gliadin.
Flattened crypts lead to maladsorption
10% chance if first relative
75% chance with an identical twin
before a child is 3
Not breastfeeding the child
Having a digestive
infection at a young
Gluten free diet
Only proven treatment.
*Still a chance of relapse/refractory. Doesn't eliminate the chance of developing bowel cancers, lymphoma - but reduces the risk and improves the symptoms.
If this is not successful...
FODMAPs are short chain carbohydrates that may be poorly absorbed in the small intestine. This can cause more water to be pulled into the colon and can also rapidly ferment, or be broken down, by bacteria in the bowel. This can cause symptoms like increased gas, bloating, constipation/diarrhea and pain.
May help for indiviuals who's bowels do not resolve from gluten free diet.
Assesses risk of osteoparosis --> poor adsorption of calcium and vitamin D - flattened villi
Villi are flattened (villus atrophy), and the epithelial cells are damaged.
Looks at the duodenum as this is the most affected part of the small bowel --> is the first part of the small bowel, therefore most of the gliadin 'attacks' here first.
deaminated gliadin peptides)
antibodies (Anti tTG)
Break down gliadin into smaller molecules - processed by the macrophages, cause the ummune response.
False negatives - lack of IgA
For some, the blood tests may be negaitve - dont produce IgA.However, may have IgG anti - antibodies, would need to check this by doing further blood test with IgG
A molecule exists within the muscle cells with a similar structure and properties to gliadin fragments - even though not harmful, antibodies are made against it.
Hard to do
Gluten free diet can reduce signs and symptoms
People with suspected coeliac/gluten sesntivities will need to be put back onto a gluten diet for 6 weeks, and then tested again for signs (as symptoms improv with gluten free diet)
Vit D and calcium maladsorption
Iron deficiency anemia
Low iron absorption, usually done in the DUODENUM
As a result of B12 and folate deficiency, caused by maladsorption
Weight loss and fatigue
Maladsorption of fats and carbohydrates
2 x increase the risk of cancer, treated less likely to lead to it