Celiac disease حساسية الحنطة

Dermatitis herpetiformis is an itchy, blistering skin disease that also stems from gluten intolerance. The rash usually occurs on the elbows, knees and buttocks. Dermatitis herpetiformis can cause significant intestinal damage identical to that of celiac disease. However, it may not produce noticeable digestive symptoms. This disease is treated with a gluten-free diet, in addition to medication to control the rash.


Causes



Also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy, celiac disease occurs in people who have a susceptibility to gluten intolerance. Some experts speculate that celiac disease has been around since humankind switched from a foraging diet of meat and nuts to a cultivated diet including grains, such as wheat. Nonetheless, it has only been in the last 50 years that researchers have gained a better understanding of the condition.
Normally, your small intestine is lined with tiny, hair-like projections called villi. Resembling the deep pile of a plush carpet on a microscopic scale, villi work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease results in damage to the villi. Without villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.
The exact cause of celiac disease is unknown, but it's often inherited. If someone in your immediate family has it, chances are 5 percent to 15 percent that you may as well. It can occur at any age, although problems don't appear until gluten is introduced into the diet.
Many times, for unclear reasons, the disease emerges after some form of trauma: an infection, a physical injury, the stress of pregnancy, severe stress or surgery.
Celiac disease may be much more common in the United States than previously believed. Recent estimates suggest that one in 133 people have the disease. Among those closely related to someone with celiac disease, such as a parent or sibling, prevalence is even higher: one in 22.
Part of the reason for the previous underdiagnosis of celiac disease may be because the disorder resembles several other conditions that can cause malabsorption. Another reason may be that if doctors believe a condition to be rare, they may look to more common disorders to explain a person's signs and symptoms. In addition, specific blood tests now allow for diagnosis of people with celiac disease who have very mild signs and symptoms or none at all.

Your small intestine is lined with tiny hair-like projections called villi, which work to absorb vitamins, minerals and other nutrients from the food you eat.

Risk factors


Although celiac disease can affect anyone, it tends to be more common in people of European descent and people with disorders caused by a reaction of the immune system (autoimmune disorders), such as:

• Lupus erythematosus
  
• Type 1 diabetes
  
• Rheumatoid arthritis
  
• Autoimmune thyroid disease
  
• Microscopic colitis
  

Complications of celiac disease

Date updated: July 06, 2006
Amy Fackler, MA; Debby Golonka, MPH
Content provided by Healthwise
If celiac disease is left untreated, complications may develop. Some of these problems can occur because of the small intestine's inability to digest food and absorb nutrients properly. Other problems may develop from damage to the intestinal lining that may or may not cause noticeable symptoms.
In children, celiac disease may produce noticeable and more severe symptoms than in some adults. Even though symptoms are often milder in teens and adults, they may also have complications, although some teen and adult complications are different from those that affect children.Complications in children
Children who have untreated celiac disease may develop complications such as:

Complications in teens
Teens who have untreated celiac disease can have many of the same problems as those in younger children. In addition, they may have:

It is sometimes difficult for teens to consistently follow a gluten-free diet. Make sure your teen knows that the more he or she doesn't follow the diet, the more likely the above complications are to develop.

Complications in adults

Adults who have celiac disease may develop:

Screening and diagnosis


People with celiac disease carry higher than normal levels of certain antibodies (anti-gliadin, anti-endomysium and anti-tissue transglutaminase). Antibodies are specialized proteins that are part of your immune system and work to eliminate foreign substances in your body. In people with celiac disease, their immune systems may be recognizing gluten as a foreign substance and producing elevated levels of antibodies to get rid of it.
A blood test can detect high levels of these antibodies and is used to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to microscopically examine a small portion of intestinal tissue to check for damage to the villi. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue.
A trial of a gluten-free diet also can confirm a diagnosis, but it's important that you not start such a diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.


Treatment

There is no cure for celiac disease. The best treatment is to change your diet and avoid foods that contain gluten. There are some medications that can help manage some of the unpleasant symptoms — such as diarrhea and bloating — associated with celiac disease.
Once gluten is removed from your diet, inflammation in your small intestine will begin to subside, usually within several weeks. If your nutritional deficiencies are severe, you may need to take vitamin and mineral supplements recommended by your doctor or dietitian to help correct these deficiencies. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.
Improvements after starting a gluten-free diet may be especially dramatic in children. Not only do their physical symptoms improve, but also their behavior improves. In addition, their growth starts to pick up.

Avoiding gluten is essential

To manage the disease and prevent complications, it's crucial that you avoid all foods that contain gluten. That means all foods or food ingredients made from many grains, including wheat, barley and rye. This includes any type of wheat (including farina, graham flour, semolina and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt and triticale.
Amaranth, buckwheat and quinoa are gluten-free as grown, but may be contaminated by other grains during harvesting and processing. Cross-contamination may also occur if gluten-free products are prepared in unwashed bowls previously containing gluten products. Oats may not be harmful for most people with celiac disease, but oat products are frequently contaminated with wheat, so it's best to avoid oats as well.
The question of whether people eating a gluten-free diet can consume pure oat products remains a subject of scientific debate. Difficulties in identifying the precise components responsible for the immune response and the chemical differences between wheat and oats have contributed to the controversy.
Your doctor may recommend that you meet with a dietitian who can instruct you on a gluten-free diet. There are still many basic foods allowed in a gluten-free diet. These include:


Fresh meats, fish and poultry (not breaded or marinated)
Most dairy products
Fruits
Vegetables
Rice
Potatoes
Gluten-free flours (rice, soy, corn, potato)
Most foods made from grains contain gluten. Avoid these foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:


Breads
Cereals
Crackers
Pasta
Cookies
Cakes and pies
Gravies
Sauces

Many other foods have ingredients that contain gluten. Grains containing gluten are often used in food additives, such as malt flavoring, modified food starch and others. Other sources of gluten that might come as a surprise include medications and vitamins that use gluten as a binding agent, lipstick, postage stamps and contamination of gluten-free foods with foods containing gluten. Cross-contamination may occur anywhere ingredients come together, such as on a cutting board. You may also be exposed to gluten by using the same utensils as others, such as a bread knife, or by sharing the same condiment containers.

Gluten-free products abound

Fortunately for bread and pasta lovers with celiac disease, there are an increasing number of gluten-free products on the market. If you can't find any at your local bakery or grocery store, check with a celiac support group or the Internet for availability. In fact, there are gluten-free substitutes for many gluten-containing foods, from brownies to beer. Many cities have specialty grocery stores that sell gluten-free foods.
Identifying gluten-free foods can be difficult. Because a gluten-free diet needs to be strictly followed, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet. A dietitian can advise you on how to best maintain the nutritional quality of your diet and help you come up with gluten-free alternatives. She or he will also help you identify your need for vitamin, calcium and mineral supplements. Revisiting the dietitian over the years will help keep you up-to-date on newer food products as well as answer your questions.

What if you eat gluten?

If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn't mean it's not hurting them. Even trace amounts of gluten in your diet can be damaging, whether or not they cause signs or symptoms. Going on and off a gluten-free diet can lead to serious complications.
Most people with celiac disease who follow a gluten-free diet have a complete recovery. Only a small percentage of people who have severely damaged small intestines don't improve with a gluten-free diet. When diet isn't effective, treatment often includes medications to help control intestinal inflammation and other conditions resulting from malabsorption.
Because celiac disease can lead to many complications, people who don't respond to dietary changes need frequent monitoring for other health conditions.

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