FACTOID # 11: Oklahoma has the highest rate of women in State or Federal correctional facilities.
 
 Home   Encyclopedia   Statistics   States A-Z   Flags   Maps   FAQ   About 
   
 
WHAT'S NEW
 

SEARCH ALL

FACTS & STATISTICS    Advanced view

Search encyclopedia, statistics and forums:

 

 

(* = Graphable)

 

 


Encyclopedia > Coeliac disease
Coeliac disease
Classification and external resources
Biopsy of small bowel showing coeliac disease manifested by blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts.
ICD-10 K90.0
ICD-9 579.0
OMIM 212750
DiseasesDB 2922
MedlinePlus 000233
eMedicine med/308  ped/2146 radio/652
MeSH D002446

Coeliac disease (pronounced /ˈsiːliːˌæk/), also spelt celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent and symptoms in all other organ systems have been described. It is estimated to affect about 1% of Indo-European populations, but is thought to be significantly underdiagnosed. A growing portion of diagnoses are being made in asymptomatic persons as a result of increasing screening.[1] Image File history File links Download high-resolution version (761x674, 188 KB)[edit] Summary Biopsy of small bowel showing coeliac disease manifested by blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts, consistent with Marsh classification III. Released into public domain on permission of patient. ... Diagram showing the small intestine In biology the small intestine is the part of the gastrointestinal tract between the stomach and the large intestine (colon). ... Intestinal villi (singular: villus) are tiny, finger-like structures that protrude from the wall of the intestine and have additional extensions called microvilli (singular: microvillus) which protrude from epithelial cells lining villi. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ... Diagram showing the small intestine In biology the small intestine is the part of the gastrointestinal tract between the stomach and the large intestine (colon). ... A genetic predisposition is a genetic effect which influences the phenotype of an organism but which can be modified by the environmental conditions. ... Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths... Failure to thrive is a medical term which denotes poor weight gain and physical growth failure over an extended period of time in infancy. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... For the language group, see Indo-European languages. ... In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ...


Coeliac disease is caused by a reaction to gliadin, a gluten protein found in wheat (and similar proteins of the tribe Triticeae which includes other cultivars such as barley and rye). Upon exposure to gliadin, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the bowel tissue, causing an inflammatory reaction. That leads to flattening of the lining of the small intestine, which interferes with the absorption of nutrients. The only effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy. Gliadin is a glycoprotein, present in wheat and some other cereals, best known for its role, along with glutenin, in the formation of gluten. ... Wheat - a prime source of gluten Gluten is an amorphous mixture of ergastic (i. ... Species T. aestivum T. boeoticum T. dicoccoides T. dicoccon T. durum T. monococcum T. spelta T. sphaerococcum T. timopheevii References:   ITIS 42236 2002-09-22 Wheat Wheat For the indie rock group, see Wheat (band). ... In biology, a tribe is a taxonomic classification in between family and genus. ... Genera See text. ... For other uses, see Barley (disambiguation). ... Binomial name Secale cereale M.Bieb. ... Tissue transglutaminase (TG2, tTG) is an enzyme (EC 2. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ... A gluten-free diet, recommended in the treatment of celiac disease, is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale. ... Wheat allergy, also known as Wheat hypersensitivity is a type of food allergy. ...


This condition has several other names, including: cœliac disease (with "œ" ligature), c(o)eliac sprue, non-tropical sprue, endemic sprue, gluten enteropathy or gluten-sensitive enteropathy, and gluten intolerance. The term coeliac derives from the Greek κοιλιακος (koiliakos, abdominal), and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by Aretaeus of Cappadocia.[2] Å’ Å“ Å’thel (pronounced ) is a Roman script letter (Å’, Å“) used in medieval and early modern Latin, and in modern French, and also the vowel sound it represents. ... Aretaeus (Αρεταιος), one of the most cele­brated of the ancient Greek physicians, of whose life, however, no particulars are known. ...

Contents

Signs and symptoms

This article is part of
the Gluten sensitivity
series.
Coeliac disease
GSE associated conditions
Wheat allergy
Gluten-sensitive idiopathic neuropathies
Anti-gliadin antibodies
Anti-transglutaminase antibodies
HLA-DQ2, HLA-DQ8
Triticeae glutens
Gluten-free diet

Classic symptoms of coeliac disease include diarrhoea, weight loss (or stunted growth in children), and fatigue, but while coeliac disease is primarily a bowel disease, bowel symptoms may also be limited or even absent. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Given this wide range of possible symptoms, the classic triad is no longer a requirement for diagnosis. 4 different commercial forms of Triticeae cultivars. ... [This is a subpage of the gluten sensitivity comparison page] GSE has a wide variety of associated condition(GSEA), however the key symptoms are typically restricted to the bowel and associated tissues. ... Wheat allergy, also known as Wheat hypersensitivity is a type of food allergy. ... Diagnosis of IGS neuropathies is on the rise. ... schematic representation of antibody. ... Anti-transglutaminase antibodies (ATA) are antibodies found more frequently in certain autoimmune diseases. ... HLA-DQ2 is a serotype group within HLA-DQ serotyping system which is determined by the antibody recognition of the HLA-DQB1*02 group of HLA-DQB1 alleles. ... Certain HLA-DQ isoforms are more commonly associated with certain autoimmune diseases. ... Wheat gluten flour Triticeae glutens are seed storage proteins found in mature seeds of grass tribe Triticeae. ... A gluten-free diet, recommended in the treatment of celiac disease, is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ...


Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorption-related problems and psychosocial problems, while adults generally have malabsorptive problems.[3] Many adults with subtle disease only have fatigue or anaemia.[1] This article discusses the medical condition. ...


Gastrointestinal

The diarrhoea characteristic of coeliac disease is pale, voluminous and malodorous. Abdominal pain and cramping, bloatedness with abdominal distention (thought to be due to fermentative production of bowel gas) and mouth ulcers[4] may be present. As the bowel becomes more damaged, a degree of lactose intolerance may develop. However, the variety of gastrointestinal symptoms that may be present in patients with coeliac disease is great, and some may have a normal bowel habit or even tend towards constipation. Frequently the symptoms are ascribed to irritable bowel syndrome (IBS), only later to be recognised as coeliac disease; a small proportion of patients with symptoms of IBS have underlying coeliac disease, and screening may be justified.[5] Steatorrhea (or steatorrhoea) is the formation of bulky, grey or light colored stools. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Mouth ulcer on the lower lip A mouth ulcer (from Latin ulcus) is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ...


Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel, which returns to baseline with diet. Longstanding disease may lead to other complications, such as ulcerative jejunitis (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring).[6] Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... This article is about lymphoma in humans. ...


Malabsorption-related

The changes in the bowel make it less able to absorb nutrients, minerals and the fat-soluble vitamins A, D, E, and K.[3]

Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... Failure to thrive is a medical term which denotes poor weight gain and physical growth failure over an extended period of time in infancy. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... This article discusses the medical condition. ... Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... Cobalamin or vitamin B12 is a chemical compound that is also known as cyanocobalamine. ... Megaloblastic anemia is an anemia (of macrocytic classification) which results from a deficiency of vitamin B12 and folic acid. ... Calcium (Ca2+) plays a vital role in the anatomy, physiology and biochemistry of organisms and of the cell, particularly in signal transduction pathways. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). ... Osteopenia is a decrease in bone mineral density that can be a precursor condition to osteoporosis. ... Osteoporosis is a disease of bone - leading to an increased risk of fracture. ... This article is about the clotting of blood. ... Vitamin K1 (phylloquinone). ... Small bowel bacterial overgrowth syndrome (SBBOS), or small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth; is a disorder of excessive bacterial growth in the small intestine. ... In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine and includes the duodenum, jejunum, and ileum. ...

Miscellaneous

Coeliac disease has been linked with a number of conditions. In many cases it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.

Selective immunoglobulin A (IgA) deficiency is a relatively mild genetic immunodeficiency. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Dermatitis herpetiformis (DH) or Duhrings Disease, is a skin disorder often associated with celiac disease. ... For other uses, see Ataxia (disambiguation). ... Spinal cord injury, or myelopathy, is a disturbance of the spinal cord that results in loss of sensation and mobility. ... Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. ... Growth failure is a medical term for a pattern of a childs growth which is poorer than normal for age, sex, stage of maturation, and genetic height expectation. ... Puberty is described as delayed when a boy or girl has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... Asplenia refers to the absence (a-) of normal spleen function and is associated with some risks. ... The spleen is an organ located in the abdomen, where it functions in the destruction of old red blood cells and holding a reservoir of blood. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... Categories: Possible copyright violations ... This article or section does not cite its references or sources. ... Microscopic colitis refers to two medical conditions - collagenous colitis and lymphocytic colitis - which cause diarrhoea. ...

Role of other grains

Wheat varieties or subspecies containing gluten such as spelt and Kamut, and the rye/wheat hybrid triticale, also trigger symptoms.[18] Look up Spelt in Wiktionary, the free dictionary. ... Originally classified as Triticum turgidum var. ... Triticale Triticale (x Triticosecale) is an artificial or man-made hybrid of rye and wheat first bred in laboratories during the late 19th century. ...


Barley and rye also induce symptoms of coeliac disease.[18] A small minority of coeliac patients also react to oats.[19][20] It is most probable that oats produce symptoms due to cross contamination with other grains in the fields or in the distribution channels.[3] There is at least one oat vendor, Gluten Free Oats, that offers oats that can be considered safe for people who are gluten intolerant because they are tested to be below 10 parts per million (ppm) by the University of Nebraska FARRP Laboratory [21]. Another vendor (McCann's) which, while not claiming to be gluten-free, points out that the risk of contamination from their oats product is low due to the processes they use.[22] Other cereals, such as maize (corn), quinoa, millet, sorghum, and rice are safe for patients to consume. Non-cereal carbohydrate-rich foods such as potatoes and bananas do not contain gluten and do not trigger symptoms. Species References ITIS 41455 2002-09-22 Oats are the seeds of any of several cereal grains in the genus Avena. ... This article is about the maize plant. ... Binomial name Willd. ... For other uses, see Millet (disambiguation). ... Species About 30 species, see text Sorghum is a genus of numerous species of grasses, some of which are raised for grain and many of which are utilised as fodder plants either cultivated or as part of pasture. ... For other uses, see Rice (disambiguation). ... Binomial name Solanum tuberosum L. The potato (Solanum tuberosum) is a perennial plant of the Solanaceae, or nightshade, family, grown for its starchy tuber. ... This article or section does not cite its references or sources. ...


Diagnosis

There are several tests that can be used to assist in diagnosis. The level of symptoms may determine the order of the tests, but all tests lose their usefulness if the patient is already taking a gluten-free diet. Intestinal damage begins to heal within weeks of gluten being removed from the diet, and antibody levels decline over months. For those who have already started on a gluten-free diet, it may be necessary to perform a re-challenge with 10 g of gluten (four slices of bread) per day over 2–6 weeks before repeating the investigations. Those who experience severe symptoms (e.g. diarrhoea) earlier can be regarded as sufficiently challenged and can be tested earlier.[3]


Combining findings into a prediction rule to guide use of endoscopy reported a sensitivity of 100% (it would identify all the cases) and specificity of 61% (it would be incorrectly positive in 39%). The prediction rule recommends that patients with high risk symptoms or positive serology should undergo endoscopy. The study defined high risk symptoms as weight loss, anaemia (haemoglobin less than 120 g/l in females and less than 130 g/l in males), or diarrhoea (more than three loose stools per day).[23] The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...


Blood tests

Antibody testing

Serology by blood test is useful both in diagnosing coeliac disease (high sensitivity of about 98%, i.e. it misses 2 in 100 cases) and in excluding it (high specificity of over 95%, i.e. a positive test is most likely confirmative of coeliac disease rather than another condition). Because of the major implications of a diagnosis of coeliac disease, professional guidelines recommend that a positive blood test is still followed by an endoscopy. A negative test may still prompt a biopsy if the suspicion remains very high; this would pick up the remaining 2% undiagnosed cases, as well as offering alternative explanations for the symptoms. As such, endoscopy with biopsy is still considered the gold standard in the diagnosis of coeliac disease.[3][6] Serology is the scientific study of blood serum. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ...

Blood antibody tests for coeliac disease[24]
Test sensitivity specificity
AGA IgA 50% 98%
AGA IgA 25% 98%
Anti-EMA 81% 99%
ATA (Anti-TTG) 81% 99%

Four serological blood tests exist for coeliac disease. The most widely used ones detect an antibody of the IgA type against particular antigens in the small bowel. Older tests detected antibodies against reticulin (ARA) or gliadin (AGA), but recent evidence supports the use of the more modern tests, namely those detecting IgA antibodies against endomysium (EMA) or tissue transglutaminase (TTG). Generally, serology may be unreliable in young children, with anti-gliadin performing somewhat better than other tests in children under five.[25] Serology tests are based on indirect immunofluorescence (reticulin, gliadin and endomysium) or ELISA (gliadin or tissue transglutaminase).[26] The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... schematic representation of antibody. ... IGA may stand for: Koji Igarashi, a video game producer Interactive genetic algorithm International Geothermal Association Independent Glass Association International Gothic Association International Gamers Award International Goat Association Irish Games Association Irish Geological Association ImmunoGlobulin A - see IgA nephritis which is a renal disease IGA (supermarkets) Independent Grocers Association or... schematic representation of antibody. ... IGA may stand for: Koji Igarashi, a video game producer Interactive genetic algorithm International Geothermal Association Independent Glass Association International Gothic Association International Gamers Award International Goat Association Irish Games Association Irish Geological Association ImmunoGlobulin A - see IgA nephritis which is a renal disease IGA (supermarkets) Independent Grocers Association or... The endomysium, literally meaning within the muscle, is a layer of connective tissue that ensheaths a muscle fiber and is composed mostly from reticular fibers. ... Anti-transglutaminase antibodies (ATA) are antibodies found more frequently in certain autoimmune diseases. ... Tissue transglutaminase (TG2, tTG) is an enzyme (EC 2. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... IGA may stand for: Koji Igarashi, a video game producer Interactive genetic algorithm International Geothermal Association Independent Glass Association International Gothic Association International Gamers Award International Goat Association Irish Games Association Irish Geological Association ImmunoGlobulin A - see IgA nephritis which is a renal disease IGA (supermarkets) Independent Grocers Association or... An antigen or immunogen is a molecule that stimulates an immune response. ... Reticular fibers or reticulin is a histochemical term used to describe a type of structural fibers in some connective tissues which is formed fine meshwork(reticulim) of glycosylated collagen III and other components which show up in certain histochemical meothods. ... Gliadin is a glycoprotein, present in wheat and some other cereals, best known for its role, along with glutenin, in the formation of gluten. ... schematic representation of antibody. ... The endomysium, literally meaning within the muscle, is a layer of connective tissue that ensheaths a muscle fiber and is composed mostly from reticular fibers. ... Tissue transglutaminase (TG2, tTG) is an enzyme (EC 2. ... Immunofluorescence is the labeling of antibodies or antigens with fluorescent dyes. ... Elisa (born Elisa Toffoli on 19 December 1977) is an Italian singer and solo artist, writing and performing within several genres, notably rock, blues, soul and ambient. ...


Guidelines recommend that a total serum IgA level is checked in parallel, as coeliac patients with IgA deficiency may be unable to produce the antibodies on which these tests depend ("false negative"). In those patients, IgG antibodies against transglutaminase (IgG-TTG) may be diagnostic.[27] Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ...

Blood HLA tests for coeliac disease[24]
Test sensitivity specificity
HLA-DQ2 94% 73%
HLA-DQ8 12% 81%

The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... HLA-DQ2 is a serotype group within HLA-DQ serotyping system which is determined by the antibody recognition of the HLA-DQB1*02 group of HLA-DQB1 alleles. ... Certain HLA-DQ isoforms are more commonly associated with certain autoimmune diseases. ...

HLA genetic typing

Antibody testing and HLA testing have similar accuracies.[24] HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ...


Endoscopy

Endoscopic still of duodenum of patient with coeliac disease showing scalloping of folds.
Endoscopic still of duodenum of patient with coeliac disease showing scalloping of folds.
Schematic of the Marsh classification of upper jejunal pathology in coeliac disease

An upper endoscopy with biopsy of the duodenum (beyond the duodenal bulb) or jejunum is performed. It is important for the physician to obtain multiple samples (four to eight) from the duodenum. Not all areas may be equally affected; if biopsies are taken from healthy bowel tissue, the result would be a false negative.[6] Image File history File links Celiac_3. ... Image File history File links Celiac_3. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. ... Image File history File links Download high-resolution version (1800x700, 503 KB)[edit] Summary Diagram to show the different stages of Coeliac Disease. ... Image File history File links Download high-resolution version (1800x700, 503 KB)[edit] Summary Diagram to show the different stages of Coeliac Disease. ... Diagram of the Human Intestine In anatomy of the digestive system, the jejunum is the central of the three divisions of the small intestine and lies between the duodenum and the ileum. ... In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. ... The Duodenal bulb is the portion of the duodenum which is closest to the stomach. ... Diagram of the Human Intestine In anatomy of the digestive system, the jejunum is the central of the three divisions of the small intestine and lies between the duodenum and the ileum. ...


Most patients with coeliac disease have a small bowel that appears normal on endoscopy; however, five concurrent endoscopic findings have been associated with a high specificity for coeliac disease: scalloping of the small bowel folds (pictured), paucity in the folds, a mosaic pattern to the mucosa (described as a cracked-mud appearance), prominence of the submucosal blood vessels, and a nodular pattern to the mucosa.[28] This article is about a decorative art. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ...


Until the 1970s, biopsies were obtained using metal capsules attached to a suction device. The capsule was swallowed and allowed to pass into the small intestine. After X-ray verification of its position, suction was applied to collect part of the intestinal wall inside the capsule. One often-utilized capsule system is the Watson capsule. This method has now been largely replaced by fibre-optic endoscopy, which carries a higher sensitivity and a lower frequency of errors.[29] The Watson peroral small intestinal biopsy capsule was a system used through the 1960s and -70s to obtain small intestinal wall biopsies in patients with suspected coeliac disease and other diseases affecting the proximal small bowel. ...


Pathology

The classic pathology changes of coeliac disease in the small bowel are categorized by the "Marsh classification":[30]

The changes classically improve or reverse after gluten is removed from the diet, so many official guidelines recommend a repeat biopsy several (4–6) months after commencement of gluten exclusion.[3] A lymphocyte is a type of white blood cell involved in the human bodys immune system. ... Enterocyte is a type of epithelial cell of the superficial layer of the small and large intestine tissue. ... The crypts of Lieberkühn are glands found in the epithelial lining of the small intestine. ... Intestinal villi (singular: villus) are tiny, finger-like structures that protrude from the wall of the intestine and have additional extensions called microvilli (singular: microvillus) which protrude from epithelial cells lining villi. ... Atrophy is the partial or complete wasting away of a part of the body. ... Hypoplasia is an incomplete or arrested development of an organ or a part [1]. It is descriptive of many medical conditions such as: Underdeveloped breasts during puberty. ... Diagram showing the small intestine In biology the small intestine is the part of the gastrointestinal tract between the stomach and the large intestine (colon). ... Wheat - a prime source of gluten Gluten is an amorphous mixture of ergastic (i. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...


In some cases a deliberate gluten challenge, followed by biopsy, may be conducted to confirm or refute the diagnosis. A normal biopsy and normal serology after challenge indicates the diagnosis may have been incorrect.[3] Patients are warned that one does not "outgrow" coeliac disease in the same way as childhood food intolerances.


Other diagnostic tests

Other tests that may assist in the diagnosis are blood tests for a full blood count, electrolytes, calcium, renal function, liver enzymes, vitamin B12 and folic acid levels. Coagulation testing (prothrombin time and partial thromboplastin time) may be useful to identify deficiency of vitamin K, which predisposes patients to hemorrhage. These tests should be repeated on follow-up, as well as anti-tTG titres.[3] Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... An electrolyte is any substance containing free ions that behaves as an electrically conductive medium. ... For other uses, see Calcium (disambiguation). ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... Cobalamin or vitamin B12 is a chemical compound that is also known as cyanocobalamine. ... Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... This article is about the clotting of blood. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the intrinsic and the common coagulation pathways. ... Vitamin K1 (phylloquinone). ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Anti-transglutaminase antibodies (ATA) are antibodies found more frequently in certain autoimmune diseases. ...


Some professional guidelines[3] recommend screening of all patients for osteoporosis by DXA/DEXA scanning. Osteoporosis is a disease of bone - leading to an increased risk of fracture. ... Dual energy X-ray absorptiometry (DXA, previously DEXA) is a means of measuring bone mineral density (BMD). ...


Pathophysiology

Coeliac disease appears to be polyfactorial, both in that more than one abnormal factor can cause the disease and also more than one factor is necessary for the disease to manifest in a patient.


Almost all coeliac patients have an abnormal HLA DQ2 allele.[1] However, about 20–30% of people without coeliac disease have inherited an abnormal HLA-DQ2 allele.[24] This suggests additional factors are needed for coeliac disease to develop. Furthermore, about 5% of those people who do develop coeliac disease do not have the DQ2 gene.[1] HLA-DQ (DQ) is a cell surface type protien found on antigen presenting cells. ... An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ... HLA DQ is a protein/peptide-antigen receptor and graft-versus-host disease antigen that is composed of 2 subunits DQα and DQβ. DQα and DQβ are encoded by two loci, HLA-DQA1 and HLA-DQB1 which are found in the MHC Class II (or HLA-D) region in the... An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ...


The HLA-DQ2 allele shows incomplete penetrance, as the gene alleles associated with the disease appear in most patients, but are neither present in all cases nor sufficient by themselves to cause the disease. HLA DQ is a protein/peptide-antigen receptor and graft-versus-host disease antigen that is composed of 2 subunits DQα and DQβ. DQα and DQβ are encoded by two loci, HLA-DQA1 and HLA-DQB1 which are found in the MHC Class II (or HLA-D) region in the... An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ... Penetrance is a term used in genetics that describes the extent to which the properties controlled by a gene, its phenotype, will be expressed. ... An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ...


Genetics

The vast majority of coeliac patients have one of two types of HLA DQ.[24] This gene is part of the MHC class II antigen-presenting receptor (also called the human leukocyte antigen) system and distinguishes cells between self and non-self for the purposes of the immune system. There are 7 HLA DQ variants (DQ2 and DQ4 through 9). Two of these variants—DQ2 and DQ8—are associated with coeliac disease. The gene is located on the short arm of the sixth chromosome, and as a result of the linkage this locus has been labeled CELIAC1. HLA-DQ (DQ) is a cell surface type protien found on antigen presenting cells. ... For other uses, see Gene (disambiguation). ... Protein images comparing the MHC I (1hsa) and MHC II (1dlh) molecules. ... HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... HLA-DQ2 is a serotype group within HLA-DQ serotyping system which is determined by the antibody recognition of the HLA-DQB1*02 group of HLA-DQB1 alleles. ... Certain HLA-DQ isoforms are more commonly associated with certain autoimmune diseases. ... Chromosome 6 is one of the 23 pairs of chromosomes in humans. ... Genetic linkage occurs when particular alleles are inherited jointly. ... Short and long arms Chromosome. ...


Over 95% of coeliac patients have an isoform of DQ2 (encoded by DQA1*05 and DQB1*02 genes) and DQ8 (encoded by the haplotype DQA1*03:DQB1*0302), which is inherited in families. The reason these genes produce an increase in risk of coeliac disease is that the receptors formed by these genes bind to gliadin peptides more tightly than other forms of the antigen-presenting receptor. Therefore, these forms of the receptor are more likely to activate T lymphocytes and initiate the autoimmune process.[1] Certain HLA-DQ isoforms are more commonly associated with certain autoimmune diseases. ... A haplotype is the genetic constitution of an individual chromosome. ... Gliadin is a glycoprotein, present in wheat and some other cereals, best known for its role, along with glutenin, in the formation of gluten. ... T cells are a subset of lymphocytes that play a large role in the immune response. ...

DQ α5-β2 -binding cleft with a deamidated gliadin peptide (yellow), modified from PDB 1S9V
DQ α52 -binding cleft with a deamidated gliadin peptide (yellow), modified from PDB 1S9V[31]

Most coeliac patients bear a two-gene HLA-DQ haplotype referred to as DQ2.5 haplotype. This haplotype is composed of 2 adjacent gene alleles, DQA1*0501 and DQB1*0201, which encode the two subunits, DQ α5 and DQ β2. In most individuals, this DQ2.5 isoform is encoded by one of two chromosomes 6 inherited from parents. Most coeliacs inherit only one copy of this DQ2.5 haplotype, while some inherit it from both parents; the latter are especially at risk for coeliac disease, as well as being more susceptible to severe complications.[32] Some individuals inherit DQ2.5 from one parent and portions of the haplotype (DQB1*02 or DQA1*05) from the other parent, increasing risk. Less commonly, some individuals inherit the DQA1*05 allele from one parent and the DQB1*02 from the other parent, called a trans-haplotype association, and these individuals are at similar risk for coeliac disease as those with a single DQ2.5 bearing chromosome 6, but in this instance disease tends not to be familial. Among the 6% of European celiacs that do not have DQ2.5(cis or trans) or DQ8, 4% are DQ2 and 2% DQA1*05, 0.4% cannot be linked to DQ8, DQA1*05, or DQB1*02.[33] Image File history File links DQa2b5_da_gliadin. ... For the file format that describes the 3D structures of molecules found in the Protein Data Bank, see Protein Data Bank (file format). ... HLA DQ is a protein/peptide-antigen receptor and graft-versus-host disease antigen that is composed of 2 subunits DQα and DQβ. DQα and DQβ are encoded by two loci, HLA-DQA1 and HLA-DQB1 which are found in the MHC Class II (or HLA-D) region in the... A haplotype is the genetic constitution of an individual chromosome. ... HLA-DQ2 is a serotype group within HLA-DQ serotyping system which is determined by the antibody recognition of the HLA-DQB1*02 group of HLA-DQB1 alleles. ... An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ... HLA-DQ2 is a serotype group within HLA-DQ serotyping system which is determined by the antibody recognition of the HLA-DQB1*02 group of HLA-DQB1 alleles. ... Chromosome 6 is one of the 23 pairs of chromosomes in humans. ... HLA DQ is a protein/peptide-antigen receptor and graft-versus-host disease antigen that is composed of 2 subunits DQα and DQβ. DQα and DQβ are encoded by two loci, HLA-DQA1 and HLA-DQB1 which are found in the MHC Class II (or HLA-D) region in the...


The frequency of these genes varies geographically. DQ2.5 has high frequency in peoples of North and Western Europe (Basque Country, Ireland,[34] with highest frequencies), portions of Africa, and is associated disease in India,[35] but is not found along portions of the West Pacific rim. DQ8, spread more globally than DQ2.5, is more prevalent from South and Central America (up to 90% phenotype frequency).[36] Location of the Basque Country The Basque Country divided in seven provinces Capital Pamplona Official languages Basque, French, Spanish Demonym Basque Currency Euro The Basque-speaking areas This article is about the overall Basque domain. ... Individuals in the mollusk species Donax variabilis show diverse coloration and patterning in their phenotypes. ...


In addition to the CELIAC1 locus, CELIAC2 (5q31-q33 - IBD5 locus), CELIAC3 (2q33 - CTLA4 locus), CELIAC4 (19q13.1 - MYOIXB locus), have been linked to coeliac disease. The CTLA4 and myosin IXB genes have been found to be linked to coeliac disease and other autoimmune diseases.[37][38] Two additional loci on chromosome 4, 4q27 (IL2 or IL21 locus) and 4q14, have been found to be linked to coeliac disease.[39][40] Chromosome 5 is one of the 23 pairs of chromosomes in humans. ... Chromosome 2 is one of the tina sosnak 23 pairs of chromosomes in humans. ... Chromosome 19 is one of the 23 pairs of chromosomes in humans. ... CTLA4 (Cytotoxic T-Lymphocyte Antigen 4) is a CD28-family receptor expressed on mainly CD4+ T cells. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ... Chromosome 4 is one of the 23 pairs of chromosomes in humans. ...


Prolamins

The proteins in food responsible for the immune reaction in coeliac disease are the prolamins. These are storage proteins rich in proline (prol-) and glutamine (-amin) that dissolve in alcohols and are resistant to pepsin and chymotrypsin, the two main digestive proteases in the gut. Gliadin in wheat is the best-understood member of this family, but other prolamins exist and hordein (from barley), and secalin (from rye) may contribute to coeliac disease.[1] However, not all prolaminins will cause this immune reaction and there is ongoing controversy on the ability of avenin (the prolamin found in oats) to induce this response in coeliac disease. Prolamins are a group of globulin proteins found in grasses, most prominently the cereal crops such as wheat (gliadin), barley (secalin), rye (hordein) and oats (avenin). ... Proline is an α-amino acid with the chemical formula HO2CCH(NH[CH2)3]. L-Proline is one of the twenty DNA-encoded amino acids. ... Glutamine (abbreviated as Gln or Q; Glx or Z represents either glutamine or glutamic acid) is one of the 20 amino acids encoded by the standard genetic code. ... Pepsin is a digestive protease (EC 3. ... Chymotrypsin (bovine γ chymotrypsin: PDB 1AB9, EC 3. ... Proteases (proteinases, peptidases, or proteolytic enzymes) are enzymes that break peptide bonds between amino acids of proteins. ... Hordein is a glycoprotein, present in barley and some other cereals, together with [gliadin] and other glycoproteins as [gluten]. Some people are sensitive to hordein due to disorders such as celiac disease. ... Secalin is a protein found in the grain rye. ... Avenin is the prolamin (protein high in proline and glutamine) found in oats. ... Species References ITIS 41455 2002-09-22 Oats are the seeds of any of several cereal grains in the genus Avena. ...


Tissue transglutaminase

Tissue transglutaminase, drawn from PDB 1FAU.
Tissue transglutaminase, drawn from PDB 1FAU.

Anti-transglutaminase antibodies to the enzyme tissue transglutaminase (tTG) are found in an overwhelming majority of cases.[41] Tissue transglutaminase modifies gluten peptides into a form that may stimulate the immune system more effectively.[1] Image File history File links Tissue_transglutaminase. ... Image File history File links Tissue_transglutaminase. ... Tissue transglutaminase (TG2, tTG) is an enzyme (EC 2. ... For the file format that describes the 3D structures of molecules found in the Protein Data Bank, see Protein Data Bank (file format). ... Anti-transglutaminase antibodies (ATA) are antibodies found more frequently in certain autoimmune diseases. ... Tissue transglutaminase (TG2, tTG) is an enzyme (EC 2. ... Peptides (from the Greek πεπτος, digestible), are the family of short molecules formed from the linking, in a defined order, of various α-amino acids. ...


Stored biopsies from suspected coeliac patients has revealed that autoantibody deposits in the subclinical coeliacs are detected prior to clinical disease. These deposits are also found in patients who present with other autoimmune diseases, anemia or malabsorption phenomena at a much increased rate over the normal population.[42] Endomysial component of antibodies (EMA) to tTG are believed to be directed toward cell surface transglutaminase, and these antibodies are still used in confirming a coeliac disease diagnosis. However, a 2006 study showed that EMA-negative coeliac patients tend to be older males with more severe abdominal symptoms and a lower frequency of "atypical" symptoms including autoimmune disease.[43] In this study the anti-tTG antibody deposits did not correlate with the severity of villous destruction. These findings, coupled with recent work showing that gliadin has an innate response component,[44] suggests that gliadin may be more responsible for the primary manifestations of coeliac disease whereas tTG is a bigger factor in secondary effects such as allegic responses and secondary autoimmune diseases. In a large percentage of coeliac patients the anti-tTG antibodies also recognize a rotavirus protein called VP7. These antibodies stimulate monocytes proliferation and rotavirus infection might explain some early steps in the cascade of immune cell proliferation.[45] Indeed, earlier studies of rotavirus damage in the gut showed this causes a villous atrophy.[46] This suggests that viral proteins may take part in the initial flattening and stimulate self-crossreactive anti-VP7 production. Antibodies to VP7 may also slow healing until the gliadin mediated tTG presentation provides a second source of crossreactive antibodies. An autoantibody is an antibody (a type of protein) manufactured by the immune system that is directed against one or more of the individuals own proteins. ... This article or section does not adequately cite its references or sources. ... MONOCYTES: Plural of monocyte. ...


Villous atrophy and malabsorption

The inflammatory process, mediated by T cells, leads to disruption of the structure and function of the small bowel's mucosal lining, and causes malabsorption as it impairs the body's ability to absorb nutrients, minerals and fat-soluble vitamins A, D, E and K from food. Lactose intolerance may be present due to the decreased bowel surface and reduced production of lactase but typically resolves once the condition is treated. T cells are a subset of lymphocytes that play a large role in the immune response. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ... A nutrient is a substance used in an organisms metabolism which must be taken in from the environment. ... Retinol (one vitamer of Vitamin A) A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. ... Lactase is a member of the β-galactosidase family of enzyme: enzymes that hydrolysis β 1,4 bonded attachments off of galactose. ...


Alternative causes of this tissue damage have been proposed and involve release of interleukin 15 and activation of the innate immune system by a shorter gluten peptide (p31–43/49). This would trigger killing of enterocytes by lymphocytes in the epithelium.[1] The villous atrophy seen on biopsy may also be due to unrelated causes, such as tropical sprue, giardiasis and radiation enteritis. While positive serology and typical biopsy are highly suggestive of coeliac disease, lack of response to diet may require these alternative diagnoses to be considered.[6] Interleukin 15 (IL-15) is a cytokine with structural similarity to IL-2 that is secreted by mononuclear phagocytes (and some other cells) following infection by virus(es). ... Enterocyte is a type of epithelial cell of the superficial layer of the small and large intestine tissue. ... This article is about the epithelium as it relates to animal anatomy. ... Tropical sprue is a malabsorption disease commonly found in the tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine. ... Giardiasis (also known as beaver fever) is a disease caused by the flagellate protozoan Giardia lamblia (also sometimes called Giardia intestinalis and Giardia duodenalis). ... Radiation enteropathy or radiation enteritis is the syndrome that develops after the intestine is exposed to radiation. ...


Risk modifiers

There are various theories as to what determines whether a genetically susceptible individual will go on to develop coeliac disease. Major theories include infection by rotavirus[47] or human intestinal adenovirus.[48] Some research has suggested that smoking is protective against adult onset coeliac disease.[49] This article or section does not adequately cite its references or sources. ... Genera Mastadenovirus Aviadenovirus Atadenovirus Siadenovirus Adenoviruses are viruses of the family Adenoviridae. ...


A 2005 prospective and observational study found that timing of the exposure to gluten in childhood was an important risk modifier. People exposed to wheat, barley, or rye before the gut barrier has fully developed (three months after birth) had five times the risk of developing coeliac disease over those exposed at 4 to 6 months. Those exposed later had a slightly increased risk relative to those exposed at 4 to 6 months.[50] However a 2006 study with similar numbers found just the reverse, that early introduction of grains was protective.[51] Breastfeeding may also reduce risk. A meta-analysis indicates that prolonging breastfeeding until the introduction of gluten-containing grains into the diet was associated with a 52% reduced risk of developing coeliac disease in infancy; whether this persists into adulthood is not clear.[52] Escherichia coli, one of the many species of bacteria present in the human gut. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... Suckling redirects here. ...


Treatment

Diet

Main article: Gluten-free diet

Presently, the only effective treatment is a life-long gluten-free diet.[53] No medication exists that will prevent damage, or prevent the body from attacking the gut when gluten is present. Strict adherence to the diet allows the intestines to heal, leading to resolution of all symptoms in the vast majority of cases and, depending on how soon the diet is begun, can also eliminate the heightened risk of osteoporosis and intestinal cancer.[54] Dietician input is generally requested to ensure the patient is aware which foods contain gluten, which foods are safe, and how to have a balanced diet despite the limitations. In many countries gluten-free products are available on prescription and may be reimbursed by health insurance plans. More manufacturers are producing gluten-free products, some of which are almost indistinguishable from their gluten-containing counterparts. A gluten-free diet, recommended in the treatment of celiac disease, is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale. ... A gluten-free diet, recommended in the treatment of celiac disease, is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale. ... Dietitians are experts in food and nutrition. ... A medical prescription ) is an order (often in written form) by a qualified health care professional to a pharmacist or other therapist for a treatment to be provided to their patient. ... The term health insurance is generally used to describe a form of insurance that pays for medical expenses. ...


The diet can be cumbersome; failure to comply with the diet may cause relapse. Many food products contain traces of gluten even if apparently wheat-free. Gluten-free products are usually more expensive and harder to find than common wheat-containing foods.


Even while on a diet, health-related quality of life (HRQOL) may be decreased in people with coeliac disease. Some have persisting digestive symptoms or dermatitis herpetiformis, mouth ulcers, osteoporosis and fractures. Symptoms suggestive of irritable bowel syndrome may be present, and there is an increased rate of anxiety, fatigue, dyspepsia and musculoskeletal pain.[55] Dermatitis herpetiformis (DH) or Duhrings Disease, is a skin disorder often associated with celiac disease. ...


Refractory disease

A tiny minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone, or because the patient is not adhering to the diet, or because the patient is consuming foods that are inadvertently contaminated with gluten. If alternative causes have been eliminated, steroids or immunosuppressants (such as azathioprine) may be considered in this scenario.[6] Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ...


Experimental treatments

Various other approaches are being studied that would reduce the need of dieting. All are still under development, and are not expected to be available to the general public for a while:[1]

  • Genetically engineered wheat species, or wheat species that have been selectively bred to be minimally immunogenic. This, however, could interfere with the effects that gliadin has on the quality of dough.
  • A combination of enzymes (prolyl endopeptidase and a barley glutamine-specific cysteine endopeptidase (EP-B2)) that degrade the putative 33-mer peptide in the duodenum. This combination would enable coeliac disease patients to consume gluten-containing products.[56]
  • Inhibition of zonulin, an endogenous signaling protein linked to increased permeability of the bowel wall and hence increased presentation of gliadin to the immune system.[57]
  • Other treatments aimed at other well-understood steps in the pathogenesis of coeliac disease, such as the action of HLA-DQ2 or tissue transglutaminase and the MICA/NKG2D interaction that may be involved in the killing of enterocytes (bowel lining cells).

Elements of genetic engineering Genetic engineering, recombinant DNA technology, genetic modification/manipulation (GM) and gene splicing are terms that are applied to the direct manipulation of an organisms genes. ... Plant breeding is the purposeful manipulation of plant species in order to create desired genotypes and phenotypes for specific purposes. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ... Prolyl endopeptidase or prolyl oligopeptidase (EC 3. ... Cysteine Proteases are enzymes that degrade polypeptides. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. ... Zonulin is a protein that participates in tight junctions between cells of the wall of the digestive tract. ... Enterocyte is a type of epithelial cell of the superficial layer of the small and large intestine tissue. ...

Screening and case finding

There is significant debate as to the benefits of screening. Some studies suggest that early detection would decrease the risk of osteoporosis and anaemia. In contrast, a cohort studied in Cambridge suggested that people with undetected coeliac disease had a beneficial risk profile for cardiovascular disease (less overweight, lower cholesterol levels).[1] Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... It has been suggested that this article or section be merged with Cohort (statistics). ... This article is about the city in England. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... This article is about the medical term. ... Cholesterol is a sterol (a combination steroid and alcohol). ...


Due to its high sensitivity, serology has been proposed as a screening measure, because the presence of antibodies would detect previously undiagnosed cases of coeliac disease and prevent its complications in those patients. Serology may also be used to monitor adherence to diet: in those who still ingest gluten, antibody levels remain elevated.[3][6] Serology is the scientific study of blood serum. ...


In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends screening for coeliac disease in patients with newly diagnosed chronic fatigue syndrome[58] and irritable bowel syndrome.[59] The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ...


Other clinical scenarios in which screening may be justified include type 1 diabetes,[14] unexplained iron-deficiency anemia,[60][61] Down's syndrome, Turner's syndrome, lupus, and autoimmune thyroid disease.[62] A child with Down syndrome Down syndrome (also called Downs syndrome) encompasses a number of genetic disorders, of which trisomy 21 (a nondisjunction) is the most representative, causing highly variable degrees of learning difficulties and physical disabilities. ... Turner syndrome is a human genetic abnormality, caused by a nondisjunction in the sex chromosomes that occurs in females (1 out of every 2,500 births). ... Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. ...


Epidemiology

The prevalence of clinically diagnosed disease (symptoms prompting diagnostic testing) is 0.05–0.27% in various studies. However, population studies from parts of Europe, India, South America, Australasia and the USA (using serology and biopsy) indicate that the prevalence may be between 0.33 and 1.06% in children (5.66% in one study of Saharawi children[63]) and 0.18–1.2% in adults.[1] People of African, Japanese and Chinese descent are rarely diagnosed; this reflects a much lower prevalence of the genetic risk factors. Population studies also indicate that a large proportion of coeliacs remain undiagnosed; this is due to many clinicians being unfamiliar with the condition.[64] For other uses, see Sahara (disambiguation). ...


A large multicentre study in the U.S. found a prevalence of 0.75% in not-at-risk groups, rising to 1.8% in symptomatic patients, 2.6% in second-degree relatives of a patient with coeliac disease and 4.5% in first-degree relatives. This profile is similar to the prevalence in Europe.[65]


Social and religious issues

Christian Churches & the Eucharist

With exception of the Roman Catholic Church, most mainline Christian churches offer their communicants gluten-free alternatives to the sacramental bread, usually in the form of a rice-based cracker or gluten-free bread. These include United Methodist, Christian Reformed, Episcopal, Lutheran, and many others.[66] The church of Rome, in the height of its power, was extremely scrupulous in all that related to the sacramental bread. ...


In order to avoid cross-contamination, priests who give communion from a paten should keep the gluten-free host wrapped in a small napkin. Priests who handle regular hosts have gluten in their fingertips, and therefore they should invite coeliac communicants to take the gluten-free host directly from the paten rather hand it to them. A paten is a small plate, usually made of silver or gold, used to hold Eucharistic hosts. ...


If coeliac communicants suspect there could be traces of gluten in the holy chalice (such as when someone has taken the wine by dipping the host in it), they should avoid taking the wine. This article is about the Christian relic. ... Intinction is the Eucharistic practice of dipping the consecrated bread, or host, into the consecrated wine before distributing it to the communicant. ...


Roman Catholic position

Roman Catholic doctrine states that for a valid Eucharist the bread must be made from wheat. In 2002, the Congregation for the Doctrine of the Faith approved German-made low-gluten hosts, which meet all of the Catholic Church's requirements, for use in Italy; although not entirely gluten-free, they were also approved by the Italian Celiac Association.[67] Some Catholic coeliac sufferers have requested permission to use rice wafers; such petitions have always been denied.[68] The issue is more complex for priests. Though a Catholic (lay or ordained) receiving under either form is considered to have received Christ "whole and entire", the priest, who is acting in persona Christi, is required to receive under both species when offering Mass — not for the validity of his Communion, but for the fullness of the sacrifice of the Mass. On August 22, 1994, the Congregation for the Doctrine of the Faith apparently barred coeliacs from ordination, stating, "Given the centrality of the celebration of the Eucharist in the life of the priest, candidates for the priesthood who are affected by coeliac disease or suffer from alcoholism or similar conditions may not be admitted to holy orders." After considerable debate, the congregation softened the ruling on 24 July 2003 to "Given the centrality of the celebration of the Eucharist in the life of a priest, one must proceed with great caution before admitting to Holy Orders those candidates unable to ingest gluten or alcohol without serious harm."[69] The Roman Catholic Church, most often spoken of simply as the Catholic Church, is the largest Christian church, with over one billion members. ... This article does not cite any references or sources. ... For other uses, see Eucharist (disambiguation). ... The Congregation for the Doctrine of the Faith (CDF) (Congregatio pro Doctrina Fidei) is the oldest of the nine congregations of the Roman Curia. ... Big and small host tongs for baking hosts detail of tongs for baking hosts jagger for making hosts A host is a thin, round wafer made from bread and used for Holy Communion in many Christian churches. ... In persona Christi is a Latin phrase which translates literally as in the person of Christ. ... is the 234th day of the year (235th in leap years) in the Gregorian calendar. ... Year 1994 (MCMXCIV) The year 1994 was designated as the International Year of the Family and the International Year of the Sport and the Olympic Ideal by the United Nations. ... The Congregation for the Doctrine of the Faith (CDF) (Congregatio pro Doctrina Fidei) is the oldest of the nine congregations of the Roman Curia. ... is the 205th day of the year (206th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ...


As of January 2004, an extremely low-gluten host became available in the United States. The Benedictine Sisters of Perpetual Adoration in Clyde, MO, after ten years of perseverance, trial, and error, have produced a low-gluten host safe for celiacs and also approved by the Catholic Church for use at Mass. Each host is made and packaged in a dedicated wheat-free / gluten-free environment. The hosts are made separately by hand, unlike the common host which is stamped out of a long thin sheet of bread by a cutter. Therefore, each host is a slightly different size and shape. Most importantly, the finished hosts have been analyzed for gluten content. The gluten content of these hosts is reported as 0.01 %. In actuality, the gluten content is probably less than 0.01%. Sister Lynn, OSB, said that the result of the analysis of the finished host revealed "no gluten detected". The hosts are labeled as 0.01 % since the lowest limit of detection of this analysis was 0.01 %. In an article from the Catholic Review (February 15, 2004) Dr. Alessio Fasano was quoted as declaring these hosts "perfectly safe for celiac sufferers." [70] Benedictine Sisters of Perpetual Adoration is an Roman Catholic religious order order founded by Sister Mary Anselma in Clyde, Missouri at the Benedictine Convent of Perpetual Adoration in 1874. ... is the 46th day of the year in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ...


Coeliacs and Passover

The Jewish festival of Pesach (Passover) may present problems with its obligation to eat matzo, which must be unleavened bread made in a strictly controlled manner from wheat, barley, spelt, oats, or rye. This rules out many other grains, such as rice and millet, that are normally used as substitutes for people with gluten sensitivity. The only gluten-free grain that can be used to make kosher for Passover matzo is oat, but oat production is very often cross-contaminated by other grains. There is also little incentive for mainstream companies to produce oat matzo, because the lack of gluten makes the dough much more difficult to work with. There is one company that makes kosher for Passover oat matzo that has been carefully supervised during the entire production process to ensure that it remains free of cross-contaminants and adheres to all requirements of Jewish law. This article is about the Jewish holiday. ... Machine-made shmura matza Matza (also Matzah (better Matsah) Hebrew , in Ashkenazi matzo or matzoh, and in Yiddish, matze, Greek - Masa, or Massa) is a cracker-like flatbread made of white plain flour, and water. ...


Since the only grains that may be used during Passover are those that have been made into matzo first and then crushed up again, and since some Jews (especially Hasidic) even avoid mixing matzo with other foods (see gebroks), many kosher for Passover products avoid grains altogether and are therefore gluten-free. Potato starch is the primary starch used to replace the grains. Gebruchts (yid, lit. ...


Jewish law clearly holds that a person should not endanger his health in order to fulfill a commandment. Thus, a person with coeliac disease is not required, or even allowed, to eat any matzo other than gluten-free matzo.[71]


History

Aretaeus of Cappadocia, living in the second century, recorded a malabsorptive syndrome with chronic diarrhoea. His "Cœliac Affection" is a translation of the Greek κοιλιακος (koiliakos, abdominal). It gained the attention of Western medicine when Francis Adams presented a translation of Aretaeus' work at the Sydenham Society in 1856. The problem, Aretaeus believed, was a lack of heat in the stomach necessary to digest the food and a reduced ability to distribute the digestive products throughout the body. This incomplete digestion resulted in loose stools that were white, malodorous and flatulent. The patient had stomach pain and was atrophied, pale, feeble and incapable of work. The disease was intractable and liable to periodic return. He regarded this as an affliction of the old and more commonly affecting women, explicitly excluding children. The cause, according to Aretaeus, was sometimes either another chronic disease or even consuming "a copious draught of cold water".[2] Aretaeus (Αρεταιος), one of the most cele­brated of the ancient Greek physicians, of whose life, however, no particulars are known. ... Dr. Francis Adams (1796 – February 26, 1861) was a Scottish medical doctor and translator of Greek medical works. ...


The paediatrician, Samuel Gee, gave the first modern-day description of the condition in a lecture at Hospital for Sick Children, Great Ormond Street, London in 1887. Gee acknowledges earlier descriptions and terms for the disease and adopts the same term as Aretaeus. Unlike Aretaeus, he includes children in the scope of the affection, particularly those between one and five years old. Gee finds the cause to be obscure and fails to spot anything abnormal during post-mortem examination (the lining of the small bowel quickly deteriorates on death).[72] He perceptively states "if the patient can be cured at all, it must be by means of diet." Gee recognises that milk intolerance is a problem with coeliac children and that highly starched foods should be avoided. He forbids rice, sago, fruit and vegetables, which all would have been safe to eat. Raw meat is recommended as are thin slices of toasted bread. Gee highlights particular success with a child "who was fed upon a quart of the best Dutch mussels daily". However, the child cannot bear this diet for more than one season.[73] This article is about the branch of medicine. ... Samuel Jones Gee (September 13, 1839 – August 3, 1911) was an English physician and pediatrician. ... The Great Ormond Street Hospital for Sick Children was founded in London in 1852 as the first hospital specifically for children in the English-speaking world. ... Subclasses Pteriomorpha (marine mussels) Palaeoheterodonta (freshwater mussels) Heterodonta (zebra mussels) The common name mussel is used for members of several different families of clams or bivalve molluscs, from both saltwater and freshwater habitats. ...


Christian Archibald Herter, an American physician, wrote a book in 1908 on children with coeliac disease, which he called "intestinal infantilism". He noted their growth was retarded and that fat was better tolerated than carbohydrate. The eponym Gee-Herter disease was sometimes used to acknowledge both contributions.[74][75] Sydney V. Haas, an American paediatrician, reported positive effects of a diet of bananas in 1924.[76] This diet remained in vogue until the actual cause of coeliac disease was determined. Christian Archibald Herter Christian Archibald Herter (September 3, 1865 – December 5, 1910) was an American physician and pathologist noted for his work on diseases of the gastrointestinal tract. ... An eponym is the name of a person, whether real or fictitious, who has (or is thought to have) given rise to the name of a particular place, tribe, discovery, or other item. ... This article or section does not cite its references or sources. ...


While a role for carbohydrates had been suspected, the link with wheat was not made until the 1940s by the Dutch paediatrician Dr Willem Dicke.[77] It is likely that clinical improvement of his patients during the Dutch famine of 1944 (during which flour was sparse) may have contributed to his discovery.[78] The link with the gluten component of wheat was made in 1952 by a team from Birmingham, England.[79] Villous atrophy was described by British physician John W. Paulley in 1954.[80] Paulley was able to examine biopsies taken from patients during abdominal operations.[72] Dr Margo Shiner, working on Prof Sheila Sherlock's team at the Postgraduate Medical School in London, described the principles of small bowel biopsy in 1956.[81] After the landing of the Allied Forces on D-Day, conditions grew worse in the Nazi occupied Netherlands. ... This article is about the British city. ... The Royal Postgraduate Medical School was an independent medical school in England. ...


Throughout the 1960s other features of coeliac disease were elucidated. Its hereditary character was recognized in 1965.[82] In 1966 dermatitis herpetiformis was linked to gluten sensitivity.[10] Dermatitis herpetiformis (DH) or Duhrings Disease, is a skin disorder often associated with celiac disease. ...


References

  1. ^ a b c d e f g h i j k van Heel D, West J (2006). "Recent advances in coeliac disease". Gut 55 (7): 1037–46. PMID 16766754. 
  2. ^ a b Adams F, translator (1856). "On The Cœliac Affection", The extant works of Aretaeus, The Cappadocian. London: Sydenham Society. Retrieved on 2006-09-04.  See also Google Books entry
  3. ^ a b c d e f g h i j k Ciclitira, P (2002). Interim Guidelines for the Management of Patients with Coeliac Disease. British Society of Gastroenterology. Retrieved on 2007-03-07.
  4. ^ Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J 1 (6000): 11–13. PMID 1247715.  Full text at PMC: 1638254
  5. ^ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (Jun 2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology 126 (7): 1721–32. PMID 15188167. 
  6. ^ a b c d e f "American Gastroenterological Association medical position statement: Celiac Sprue" (2001). Gastroenterology 120 (6): 1522–5. PMID 11313323. 
  7. ^ Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol 98 (4): 839-43. PMID 12738465. 
  8. ^ Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med 42 (2): 319-26. PMID 4959869. 
  9. ^ Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol 27 (5): 367-71. PMID 1529270. 
  10. ^ a b Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet 2 (7476): 1280–2. PMID 4163419. 
  11. ^ Eaton W, Mortensen P, Esben A, Byrne M, Mors O, Ewald H (2002). "Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers". British Medical Journal 328: 438-9. doi:10.1136/bmj.328.7437.438. PMID 14976100.  Full text at PMC: 344262
  12. ^ Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J 78 (921): 393-8. PMID 12151653. 
  13. ^ Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet 1 (7639): 163-4. PMID 4189238. 
  14. ^ a b Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med 18 (3): 169-77. PMID 11318836. 
  15. ^ Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev 23 (4): 464-83. PMID 12202461. 
  16. ^ Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut 42 (1): 120-2. PMID 9518232.  Full text at PMC: 1726939
  17. ^ Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol 32 (3): 225-7. PMID 11246349. 
  18. ^ a b Grain toxicity (RTF). The CELIAC list. Retrieved on 2006-08-27.
  19. ^ Lundin K, Nilsen E, Scott H, Løberg E, Gjøen A, Bratlie J, Skar V, Mendez E, Løvik A, Kett K (2003). "Oats induced villous atrophy in coeliac disease". Gut 52 (11): 1649–52. PMID 14570737.  Full text at PMC: 1773854
  20. ^ Størsrud S, Olsson M, Arvidsson Lenner R, Nilsson L, Nilsson O, Kilander A (2003). "Adult coeliac patients do tolerate large amounts of oats". Eur J Clin Nutr 57 (1): 163-9. PMID 12548312. 
  21. ^ http://www.glutenfreeoats.com, http://www.farrp.org/, http://www.farrp.org/analysis.htm
  22. ^ McCann's FAQ. Odlum Group (2004). Retrieved on 2006-11-03. “we reckon that the level of non-oat grains to be less than 0.05%”
  23. ^ Hopper A, Cross S, Hurlstone D, McAlindon M, Lobo A, Hadjivassiliou M, Sloan M, Dixon S, Sanders D (2007). "Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool". BMJ 334: 729. PMID 17383983.  Full text at PMC: 1847864
  24. ^ a b c d e Hadithi M, von Blomberg BM, Crusius JB, et al (2007). "Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease". Ann. Intern. Med. 147 (5): 294–302. PMID 17785484. 
  25. ^ Hill ID. "What are the sensitivity and specificity of serological tests for celiac disease? Do sensitivity and specificity vary in different populations?" In: NIH Consensus Development Conference on Celiac Disease. Bethesda, Md.: U.S. National Institutes of Health, 2004;27–31. PDF.
  26. ^ Wong R, Steele R, Reeves G, Wilson R, Pink A, Adelstein S (2003). "Antibody and genetic testing in coeliac disease". Pathology 35 (4): 285–304. PMID 12959764. 
  27. ^ Korponay-Szabó I, Dahlbom I, Laurila K, Koskinen S, Woolley N, Partanen J, Kovács J, Mäki M, Hansson T (2003). "Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency". Gut 52 (11): 1567–71. PMID 14570724.  Full text at PMC: 1773847
  28. ^ Niveloni S, Fiorini A, Dezi R, Pedreira S, Smecuol E, Vazquez H, Cabanne A, Boerr LA, Valero J, Kogan Z, Maurino E, Bai JC. (1998). "Usefulness of videoduodenoscopy and vital dye staining as indicators of mucosal atrophy of celiac disease: assessment of interobserver agreement". Gastrointestinal Endoscopy 47 (3): 223–229. PMID 9580349. 
  29. ^ Mee A, Burke M, Vallon A, Newman J, Cotton P (1985). "Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens". Br Med J (Clin Res Ed) 291 (6498): 769-72. PMID 3929934.  Full text at PMC: 1417146
  30. ^ Marsh M (1992). "Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue')". Gastroenterology 102 (1): 330-54. PMID 1727768. 
  31. ^ Kim C, Quarsten H, Bergseng E, Khosla C, Sollid L (2004). "Structural basis for HLA-DQ2-mediated presentation of gluten epitopes in celiac disease". Proc Natl Acad Sci U S A 101 (12): 4175–9. PMID 15020763.  Full text at PMC: 384714
  32. ^ Jores RD, Frau F, Cucca F, et al (2007). "HLA-DQB1*0201 homozygosis predisposes to severe intestinal damage in celiac disease". Scand. J. Gastroenterol. 42 (1): 48-53. doi:10.1080/00365520600789859. PMID 17190762. 
  33. ^ Karell K, Louka AS, Moodie SJ, et al (2003). "HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European Genetics Cluster on Celiac Disease". Hum. Immunol. 64 (4): 469-77. PMID 12651074. 
  34. ^ Michalski J, McCombs C, Arai T, Elston R, Cao T, McCarthy C, Stevens F (1996). "HLA-DR, DQ genotypes of celiac disease patients and healthy subjects from the West of Ireland". Tissue Antigens 47 (2): 127-33. PMID 8851726. 
  35. ^ Kaur G, Sarkar N, Bhatnagar S, et al (2002). "Pediatric celiac disease in India is associated with multiple DR3-DQ2 haplotypes". Hum. Immunol. 63 (8): 677-82. PMID 12121676. 
  36. ^ Layrisse Z, Guedez Y, Domínguez E, Paz N, Montagnani S, Matos M, Herrera F, Ogando V, Balbas O, Rodríguez-Larralde A (2001). "Extended HLA haplotypes in a Carib Amerindian population: the Yucpa of the Perija Range". Hum Immunol 62 (9): 992–1000. PMID 11543901. 
  37. ^ Zhernakova A, Eerligh P, Barrera P, et al (2005). "CTLA4 is differentially associated with autoimmune diseases in the Dutch population". Hum. Genet. 118 (1): 58-66. doi:10.1007/s00439-005-0006-z. PMID 16025348. 
  38. ^ Sánchez E, Alizadeh BZ, Valdigem G, et al (2007). "MYO9B gene polymorphisms are associated with autoimmune diseases in Spanish population". Hum. Immunol. 68 (7): 610-5. doi:10.1016/j.humimm.2007.03.006. PMID 17584584. 
  39. ^ van Heel DA, Franke L, Hunt KA, et al (2007). "A genome-wide association study for celiac disease identifies risk variants in the region harboring IL2 and IL21". Nat Genet 39 (7): 827-9. doi:10.1038/ng2058. PMID 17558408. 
  40. ^ Popat S, Bevan S, Braegger C, Busch A, O'Donoghue D, Falth-Magnusson K, Godkin A, Hogberg L, Holmes G, Hosie K, Howdle P, Jenkins H, Jewell D, Johnston S, Kennedy N, Kumar P, Logan R, Love A, Marsh M, Mulder C, Sjoberg K, Stenhammar L, Walker-Smith J, Houlston R (2002). "Genome screening of coeliac disease". J Med Genet 39 (5): 328-31. PMID 12011149. 
  41. ^ Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Riecken E, Schuppan D (1997). "Identification of tissue transglutaminase as the autoantigen of celiac disease". Nat Med 3 (7): 797–801. PMID 9212111. 
  42. ^ Kaukinen K, Peraaho M, Collin P, Partanen J, Woolley N, Kaartinen T, Nuuntinen T, Halttunen T, Maki M, Korponay-Szabo I (2005). "Small-bowel mucosal tranglutaminase 2-specific IgA deposits in coeliac disease without villous atrophy: A Prospective and radmonized clinical study". Scand J Gastroenterology 40: 564–572. PMID 16036509. 
  43. ^ Salmi T, Collin P, Korponay-Szabó I, Laurila K, Partanen J, Huhtala H, Király R, Lorand L, Reunala T, Mäki M, Kaukinen K (2006). "Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits". Gut 55 (12): 1746–53. PMID 16571636. 
  44. ^ Londei M, Ciacci C, Ricciardelli I, Vacca L, Quaratino S, and Maiuri L. (2005). "Gliadin as a stimulator of innate responses in celiac disease". Mol Immunol 42 (8): 913–918. PMID 15829281. 
  45. ^ Zanoni G, Navone R, Lunardi C, Tridente G, Bason C, Sivori S, Beri R, Dolcino M, Valletta E, Corrocher R, Puccetti A (2006). "In celiac disease, a subset of autoantibodies against transglutaminase binds toll-like receptor 4 and induces activation of monocytes". PLoS Med 3 (9): e358. PMID 16984219.  Full text at PMC: 1569884
  46. ^ Salim A, Phillips A, Farthing M (1990). "Pathogenesis of gut virus infection". Baillieres Clin Gastroenterol 4 (3): 593–607. PMID 1962725. 
  47. ^ Stene L, Honeyman M, Hoffenberg E, Haas J, Sokol R, Emery L, Taki I, Norris J, Erlich H, Eisenbarth G, Rewers M (2006). "Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study". Am J Gastroenterol 101 (10): 2333–40. doi:10.1111/j.1572-0241.2006.00741.x. PMID 17032199. 
  48. ^ Kagnoff M, Paterson Y, Kumar P, Kasarda D, Carbone F, Unsworth D, Austin R (1987). "Evidence for the role of a human intestinal adenovirus in the pathogenesis of coeliac disease" (PDF). Gut 28 (8): 995–1001. PMID 2822550.  Full text at PMC: 1433141
  49. ^ Suman S, Williams E, Thomas P, Surgenor S, Snook J (2003). "Is the risk of adult coeliac disease causally related to cigarette exposure?". Eur J Gastroenterol Hepatol 15 (9): 995–1000. PMID 12923372. 
  50. ^ Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, Emery LM, Sokol RJ, Erlich HA, Eisenbarth GS, Rewers M. (2005). "Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease". JAMA 293 (19): 2343–2351. PMID 15900004. 
  51. ^ Poole J, Barriga K, Leung D, Hoffman M, Eisenbarth G, Rewers M, Norris J (2006). "Timing of initial exposure to cereal grains and the risk of wheat allergy". Pediatrics 117 (6): 2175–82. PMID 16740862. 
  52. ^ Akobeng A, Ramanan A, Buchan I, Heller R (2006). "Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies". Arch Dis Child 91 (1): 39–43. PMID 16287899. 
  53. ^ Kupper C (2005). "Dietary guidelines and implementation for celiac disease". Gastroenterology 128 (4 Suppl 1): S121-7. PMID 15825119. 
  54. ^ Treem W (2004). "Emerging concepts in celiac disease". Curr Opin Pediatr 16 (5): 552-9. PMID 15367850. 
  55. ^ Häuser W, Gold J, Stein J, Caspary W, Stallmach A (2006). "Health-related quality of life in adult coeliac disease in Germany: results of a national survey". Eur J Gastroenterol Hepatol 18 (7): 747-54. PMID 16772832. 
  56. ^ Siegel M, Bethune M, Gass J, Ehren J, Xia J, Johannsen A, Stuge T, Gray G, Lee P, Khosla C (2006). "Rational design of combination enzyme therapy for celiac sprue". Chem Biol 13 (6): 649-58. PMID 16793522. 
  57. ^ Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum S (2000). "Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease". Lancet 355 (9214): 1518–9. PMID 10801176. 
  58. ^ National Institute for Health and Clinical Excellence. Clinical guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis. London, 2007.
  59. ^ National Institute for Health and Clinical Excellence. Clinical guideline 61: Irritable bowel syndrome. London, 2008.
  60. ^ Corazza G, Valentini R, Andreani M, D'Anchino M, Leva M, Ginaldi L, De Feudis L, Quaglino D, Gasbarrini G (1995). "Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia". Scand J Gastroenterol 30 (2): 153–6. PMID 7732338. 
  61. ^ Ransford R, Hayes M, Palmer M, Hall M (2002). "A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia". J Clin Gastroenterol 35 (3): 228–33. PMID 12192198. 
  62. ^ Sjöberg K, Carlsson A (2004). "Screening for celiac disease can be justified in high-risk groups" (in Swedish). Lakartidningen 101 (48): 3912, 3915–6, 3918–9. PMID 15631226. 
  63. ^ Catassi C, Rätsch I, Gandolfi L, Pratesi R, Fabiani E, El Asmar R, Frijia M, Bearzi I, Vizzoni L (1999). "Why is coeliac disease endemic in the people of the Sahara?". Lancet 354 (9179): 647–8. PMID 10466670. 
  64. ^ Zipser R, Farid M, Baisch D, Patel B, Patel D (2005). "Physician awareness of celiac disease: a need for further education". J Gen Intern Med 20 (7): 644-6. doi:10.1111/j.1525-1497.2005.0107.x. PMID 16050861.  Full text at PMC: 1490146
  65. ^ Fasano A, Berti I, Gerarduzzi T, Not T, Colletti R, Drago S, Elitsur Y, Green P, Guandalini S, Hill I, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman S, Murray J, Horvath K (2003). "Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study". Archives of Internal Medicine 163 (3): 286–92. PMID 12578508. 
  66. ^ Jax Peter Lowell, The Gluten-Free Bible, p. 279.
  67. ^ Scott Adams (August 2, 2002). Bishops in Italy Approve a German-made Low Gluten Eucharistic Host. Celiac.com.
  68. ^ Associated Press. "Girl with digestive disease denied Communion", MSNBC, Microsoft, December 8, 2004. Retrieved on 2006-05-30. 
  69. ^ Ratzinger, Joseph (July 24, 2003). Prot. 89/78-174 98. Congregation for the Doctrine of the Faith. Full text at: The Use of Mustum and Low-Gluten Hosts at Mass. BCL Newsletter. United States Conference of Catholic Bishops (November 2003). Retrieved on 2007-03-07.
  70. ^ McNamara, Father Edward (2004-09-15). Liturgy: Gluten-free Hosts. Catholic Online. Retrieved on 2007-06-17.
  71. ^ Rabbi Avraham Juravel. Gluten Intolerance, Celiac, Allergies And Pesach. Orthodox Union. Retrieved on 2006-09-03.
  72. ^ a b Holmes, Geoff (2006). History of coeliac disease. Coeliac UK. Retrieved on 2007-03-20.
  73. ^ Gee, SJ (1888). "On the coeliac affection". St Bartholomew's Hospital Report 24: 17–20. 
  74. ^ Herter, CA (1908). On infantilism from chronic intestinal infection; characterized by the overgrowth and persistence of flora in the nursing period. New York: Macmillan & Co.  as cited by WhoNamedIt
  75. ^ Ole Daniel Enersen. Christian Archibald Herter. Who Named It?. Retrieved on 2007-03-20.
  76. ^ Haas SV (1924). "The value of the banana in the treatment of coeliac disease". Am J Dis Child 24: 421–37. 
  77. ^ van Berge-Henegouwen G, Mulder C (1993). "Pioneer in the gluten free diet: Willem-Karel Dicke 1905–1962, over 50 years of gluten free diet" (PDF). Gut 34 (11): 1473–5. PMID 8244125.  Full text at PMC: 1374403
  78. ^ Dicke WK. Coeliakie: een onderzoek naar de nadelige invloed van sommige graansoorten op de lijder aan coeliakie [PhD thesis]. Utrecht, the Netherlands: University of Utrecht, 1950.
  79. ^ Anderson C, French J, Sammons H, Frazer A, Gerrard J, Smellie J (1952). "Coeliac disease; gastrointestinal studies and the effect of dietary wheat flour". Lancet 1 (17): 836-42. PMID 14918439. 
  80. ^ Paulley JW (1954). "Observation on the aetiology of idiopathic steatorrhoea; jejunal and lymph-node biopsies". Br Med J 4900: 1318–21. PMID 13209109.  Full text at PMC: 2080246
  81. ^ Shiner M (1956). "Duodenal biopsy". Lancet 270 (6906): 17-9. PMID 13279152. 
  82. ^ Macdonald W, Dobbins W, Rubin C (1965). "Studies of the familial nature of celiac sprue using biopsy of the small intestine". N Engl J Med 272: 448-56. PMID 14242522. 

Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 247th day of the year (248th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 66th day of the year (67th in leap years) in the Gregorian calendar. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... The Rich Text Format (often abbreviated to RTF) is a proprietary document file format developed by Microsoft in 1987 for cross-platform document interchange. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 239th day of the year (240th in leap years) in the Gregorian calendar. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... is the 214th day of the year (215th in leap years) in the Gregorian calendar. ... Also see: 2002 (number). ... is the 342nd day of the year (343rd in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 150th day of the year (151st in leap years) in the Gregorian calendar. ... Papal Arms of Pope Benedict XVI. The papal tiara was replaced with a bishops mitre, and pallium of the Pope was added beneath the coat of arms. ... is the 205th day of the year (206th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... The Congregation for the Doctrine of the Faith (CDF) (Congregatio pro Doctrina Fidei) is the oldest of the nine congregations of the Roman Curia. ... The United States Conference of Catholic Bishops (also known as the USCCB) is the official governing body of the Roman Catholic Church in the United States. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 66th day of the year (67th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... is the 258th day of the year (259th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 168th day of the year (169th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 246th day of the year (247th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 79th day of the year (80th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 79th day of the year (80th in leap years) in the Gregorian calendar. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ... PubMed Central grew from the online Entrez PubMed biomedical literature search system. ...

External links

Wikibooks
Wikibooks Cookbook has an article on

Hematemesis or haematemesis is the vomiting of fresh red blood. ... In medicine, melena or melaena refers to the black, tarry feces that are associated with gastrointestinal hemorrhage. ... Gastrointestinal bleeding describes every form of hemorrhage (blood loss) in the gastrointestinal tract, from the pharynx to the rectum. ... Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage. ... Lower gastrointestinal bleeding refers to any form of bleeding in the Lower gastrointestinal tract. ...


 
 

COMMENTARY     


Share your thoughts, questions and commentary here
Your name
Your comments

Want to know more?
Search encyclopedia, statistics and forums:

 


Press Releases |  Feeds | Contact
The Wikipedia article included on this page is licensed under the GFDL.
Images may be subject to relevant owners' copyright.
All other elements are (c) copyright NationMaster.com 2003-5. All Rights Reserved.
Usage implies agreement with terms, 1022, m