Transcript 7-seminar_celaic _4_NANx

The Compliance Of Celiac Disease Patient's to
Dietary Regimen
Seminar in Clinical Nutrition
CHS439
Done by :
Al-moushawah , Nahlah , AL-Baijan Norah . and Abo
rasien , Ebtehal
Supervision by :
Dr. Saada Al-Orf
T. Nouf Al-Gamdy
Outline :
introduction
oHistory of celiac disease
oClassification and Symptom
of celiac disease
Presented by :
Norah AL.Bajan
oPrevalance of celic disease
presented by :
Ebtehal Aburasain
o
oDiagnosis of celiac disease
oCoues of celiac disease
presented by : Nahla
Almoshawah
oManegment of celiac disease
oAlternative treatment of celiac
disease
presented by :
Ebtehal Aburasain
objective :
Will be conducted to study the compliance of celiac
disease patient to investigate the difficulties they are
facing .
Introduction :
History of celiac disease:
In report entitled "On the Celiac Affection" disease was
first described by Samuel Gee in 1888. Willem k. dick
(Dutch pediatrician) is recognized an association between the
consumption of bread and cereals and relapsing diarrhea (1).
This observation was in Second World War 2 when there was
a shortage of bread and cereals, so the symptoms improved
once the bread was replaced by non –cereal containing foods
(1).
1-Faiza A. Qari . Clinical presentation of
adult celiac disease
in Western Saudi Arabia. Saudi Med J 2002;
Vol. 23 (12): 1514-1517.
CD it is also known as
•celiac sprue .
•gluten – sensitive enteropathy .
•nontropical sprue (4; 5).
4- Celiac disease . National Digestive Diseases Information Clearinghouse
5- J. Bai , E. Zeballos, M. Fried, G.R. Corazza , D. Schuppan, M.J.G. Farthing, C. Catassi , L. Greco, H. Cohen, J.H. Krabshuis, celiac
disease, World Gastroenterology Organisation Practice Guidelines,2007
definition of celiac disease:
Celiac disease (CD) permanent autoimmune
mediated and food sensitive enteropathy caused by the
ingestion of gluten containing cereals (2).
Gluten is alcohol soluble protein component of the
cereals wheat, rye, and barly (2) and poorly digested in
human upper gastrointestinal tract .
2-Marco Silano, Carlo Agostoni ,and
Stefano Guandalini . Effect of the timing of
gluten introduction on the development of
celiac disease . World Journal of
Gastroenterol . 2010 April 28;16(16):19391942.
CD is amultifactorial condition originating
from interaction between
gluten
and
immunity
genetic
environmental
factors
2-Marco Silano, Carlo Agostoni ,and Stefano Guandalini . Effect of the timing of gluten introduction
on the development of celiac disease . World Journal of Gastroenterol . 2010 April 28;16(16):19391942.
3-Peter H.R. Green , and , Christophe Cellier . Celiac Disease . The New England Journal of
Medicine . 2007 october 25 357 ; 17 .
.
3
Wheat
rye
Barly
Gluten
Effect of
CD patient
Damage of
small
intestinal
mucosa
3-Peter H.R. Green , and , Christophe
Cellier . Celiac Disease . The New England
Journal of Medicine . 2007 october 25 357
; 17 .
Poorly
absorption
of nutrient
Classification and Symptom of celiac disease:
Symptoms may occur in the digestive system or in
other part of the body and it vary from person to
person greatly according to age group (3; 6).
6
3-Peter H.R. Green , and , Christophe Cellier . Celiac Disease . The New
England Journal of Medicine . 2007 october 25 357 ; 17 .
6- Celiac disease . National Digestive Diseases Information Clearinghouse
Classification of celiac disease :
(4)
CD can be divided into the
following forms:
Classical (typical)
Mostly
gastrointestinal
• chronic diarrhea( 20-18.5%)
• Anorexia
• abdominal distention
Atypical
Mostly Not
gastrointestinal
• Iron deficiency (20-80%)
• Dental enamel hypoplasia
(30% of untreated patient with
CD )
Silent
Asymptomatic
4-Alessio fasano and carlo catassi . Current Approaches to Diagnosis and
Treatment of Celiac Disease : An Evolving Spectrum , the American
gastroenterological association . 2001 120 (3) 636-651 .
Prevalence of Celiac Disease:
• Celiac disease is common throughout the world and
affects around (1:100 -300) of the population.
•
The true prevalence of CD is difficult to be
estimated because of its variable clinical
presentation, it occurs frequently without
gastrointestinal symptoms.
• The female-to-male ratio is 2:1.
7-D.BRANSKI, A. FASANO, AND R.TRONCONE. LATEST DEVELOPMENTS IN THE
PATHOGENESIS AND TREATMENT OF CELIAC DISEASE. The Journal of Pediatrics ,
September .2006.295-300.
Europe
Asia
Africa
Back
country
percent
country
percent
in Brazil
1:681
in Sweden
1:250
in Italy
1:106
in Denmark
1:524
in Portugal
1:134
in Holland
1:333
in Switzerland
1:132
in Israel
1:157
in Spain
1:118
in the USA
1:250
country
Tunisia
Back
percent
1:157
Back
country
percent
country
percent
Iran
1:166
India
Syria
1.5:100
Turkey
1:5001:20,000
1:87
Saudi Arabia ..The study was done in the
western region of Saudi Arabia, the results
were identified with showed that eighty children
a diagnosis of CD. Their age range, (0.5-18 years).
41
39
51%
49%
detected during
screening of highrisk groups
patients had
classical
symptoms of
malabsorption
8-Pubmed.gov,[internet].Celiac Disease in Children and Adolesents at Asing Centre in
SaudiArbia,2002,[updated2011Jan.-Feb.]availableat http://www.ncbi.nlm.nih.gov/pubmed/21245600 .
Not everyone with CD symptom it is mean they
have the disease ,because the symptoms of CD
are similar for other disease ,and it can be
misdiagnosed with irritable bowel syndrome
(IBS) ,Iron deficiency anemia ,chronic fatigue
syndrome and other.
11-Kirby Sainsbury , Barbara Mullan. Measuring beliefs about gluten free diet adherence in adult coeliac disease using the theory
of planned behavior. Appetite 56 (2011) 476-483.
Diagnosis of celiac disease :
Blood test
(serologic)
Screening
test
Endoscopy
Clinical suspicious
(not on gluten free diet)
low
High
IgA tissue transglutaminase
Or
IgA endomysial antibody
+
Total serum IgA level
All test
negative
Small bowel biopsy
+
IgA tissue
transglutaminase or
endomysial antibody
Either test positive
Diagnosis excluded
Small bowel biopsy
10-J. Bai , E. Zeballos, M. Fried, G.R. Corazza , D. Schuppan, M.J.G. Farthing, C. Catassi , L. Greco, H. Cohen, J.H. Krabshuis,
celiac disease, World Gastroenterology Organisation Practice Guidelines,2007.
0-diagnosed with normal duodenal biopsy
stage-1-increasedon percentage of
intraepithelial lymphocyte to (IEL)above
30% .
stage -2- if present of crypyhyperplasia and
inflammatory infiltrates in the lamina propria
.
J. Bai , E. Zeballos, M. Fried, G.R. Corazza , D. Schuppan, M.J.G. Farthing, C. Catassi , L. Greco, H. Cohen, J.H. Krabshuis, celiac
disease, World Gastroenterology Organisation Practice Guidelines,2007
Rodrigo L. ,Celiac disease, World J Gastroenterol 2006 novamber; 12(41): 6585-6593 www.wjgnet.com/1007-9327/12/6585.asp.
stage -3- atrophy of villi .
stage -4- total hypoplasia of the mucosa .
Caues of celiac disease
Genetic :
The most important genetic factors
identified are HLA-DQ2 and HLA-DQ8,
which are necessary but not sufficient to
predispose to CD. Practically 90%-95% CD
patients carry HLA-DQ2 or HLA-DQ8.
population
DQ2-DQ8
CD
patient
Cause :
Wheat ,rye and barley are cereals that CD
patient act with CD patient as toxic
material causing the signs or symptoms
of celiac disease.
Higher risk population of CD developing :
Relatives
10% increased the risk on first degree relatives.
Iron deficiency anemia (IDA)
2% to 5% in a symptom patient ,but still higher in (
10% to 15%) in symptomatic .
Type 1 diabetes mellitus
it is range from 2% to 5% in adult and become
higher in child with 3% to 8%.
11-AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease,
gastroenterology,2006 octoper, 131:1977-1980.
Osteoporosis and bone mineralization
the chance for CD happen ( 1.5%-3%).
Liver disease
1.5% to 9.0% in patients with elevated transaminase
levels
Autoimmune thyroid disease,
between 1.5% to 6.7%,
Reproductive disorders
ranges between 2.1% and4.1% in women with
unexplained infertility
11-AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease,
gastroenterology,2006 octoper, 131:1977-1980.
Other possible factors
Breastfeeding
All the observational epidemiological studies
dealing with the effect of breastfeeding on
development of CD and found that children being
breastfed at the time of gluten introduction had a 52%
reduction in risk of developing CD, compared to their
peers who were not breastfed at the time of gluten
introduction .
Marco Silano, Carlo Agostoni ,and Stefano Guandalini . Effect of the timing of gluten introduction on the development of celiac
disease . World Journal of Gastroenterol . 2010 April 28;16(16):1939-1942.
Infectious Episodes
It is contribute to the development of CD by change the
primibility and the cytokine balance in the intestinal
represent an independent risk factor for celiac disease in
genetically susceptible individuals to celiac disease.
Victorien M. Wolters .Cisca Wijmenga, Genetic Background of Celiac Disease and Its Clinical Implications Am J Gastroenterol.
2008;103(1):190-195.
Medication
On treatment of hepatitis C with interferon (IFN) CD
has been reported during this course of treatment .
Silent form of CD should be suspected subsided in
almost all patients after IFN was withdrawn and without
a gluten-free diet but the historical abnormalities .
13-Victorien M. Wolters .Cisca Wijmenga, Genetic Background of Celiac Disease and Its Clinical Implications Am J Gastroenterol.
2008;103(1):190-195
Management strategies:
• Treatment consists of life-long avoidance of gluten-containing foods
that is gluten free diet (GFD), such as (bread, cereal, cakes, and
other food products or additives containing wheat, rye, and barley).
• Complete healing is expected, once gluten is removed from diet
• Medications and over the counter products may also contain
gluten.
• The Treatment of CD is not the same of other chronic diseases
because it is unavoidably in the patient's own hands(15).
14-A.Bellini, C.Zanchi, S.Martelossi, G.Leo, T.Not, and A.Ventura.Compliance with Gluten-free Diet: The
Role of Locus of control in Celiac Disease.The Journal of Pediatrics.463-466
15-A.Fasano.Surprises trom Celiac Disease. SCIENTIFIC AMERICAN, INC.2011,2009.
(14)
.
Alternative Treatments:
• A gluten-free diet is effective and safe and at present
is the only available treatment for CD.
• Any alternative treatments in the future must have a
safety and effective profile equivalent to that of the
GFD .
16- Pubmed.gov,[internet].Celiac Disease in Children and
Adolesents at Asing Centre in
SaudiArbia,2002,[updated2011Jan.-Feb.]availableat
Cont,
• Supplement therapy for patients with CD to help
digest gluten peptides and thus not having any
symptoms.
• By pretreatment of gluten-containing food and
therefore not having supplements.
• Genetic engineering of wheat and inhibitory gliadin
peptides.
Cont,
• Immunomodulatory strategist, that is a vaccine that
would expose the immune system to small amounts
of strongly immunogenic forms of gluten, on the
theory that repeated small exposures would
ultimately induce the immune system to tolerate
gluten(17).
17- Kirby Sainsbury , Barbara Mullan. Measuring beliefs about gluten free
diet adherence in adult coeliac disease using the theory of planned
behavior. Appetite 56 (2011) 476-483.
Cont,
• Correction of the Intestinal Barrier Defect, It is an
innovative therapeutic alternative in CD, because
small intestinal permeability abnormalities are seen
in untreated CD patients.
The use of the zonulin inhibitor AT 1001 to correct
intestinal barrier defects and AT 1001 has been
shown to be well tolerated and to reduced gluteninduced intestinal barrier dysfunction,
proinflammtory cytokine production, and
gastrointestinal symptoms in celiac patients .
17- Kirby Sainsbury , Barbara Mullan. Measuring beliefs about
gluten free diet adherence in adult coeliac disease using the
theory of planned behavior. Appetite 56 (2011) 476-483.
Conclusion
Celiac disease (CD) permanent autoimmune
mediated and food sensitive enteropathy caused by
the ingestion of gluten containing cereals It is also
known as celiac sprue, gluten – sensitive enteropathy,
nontropical sprue. Classification of celiac disease are
Classical (typical), atypical and silent. Celiac disease is
common throughout the world and affects around
(1:100 -300) of the population. The true prevalence
of CD is difficult to be estimated because of its
variable clinical presentation, it occurs frequently
without gastrointestinal symptoms.
Con,
• There are three key parameters for the
diagnosis of CD which are screening test,
blood test (serologic) and endoscopy.
Treatment consists of life-long avoidance of
gluten-containing foods that is gluten free diet
(GFD), such as (bread, cereal, cakes, and other
food products or additives containing wheat,
rye, and barley). Complete healing is
expected, once gluten is removed from diet .
It is recommended to :
Conducted a national survey to identify the extent of
prevelance of CD in KSA .
Design and implement a nutritional education program for
all age group CD patients .
Have joined cooperative effort between saudi food and
drug uthority and the related ministries in order to;
•Control the foods labeling.
•Make the GFD products available in reasonable affordable
price
•Facilitate and encourage the local market to produce the
GFD products.
Rerrerance
1-Faiza A. Qari . Clinical presentation of adult celiac disease
in Western Saudi Arabia. Saudi Med J 2002; Vol. 23 (12): 1514-1517.
2-Marco Silano, Carlo Agostoni ,and Stefano Guandalini . Effect of the timing of gluten
introduction on the development of celiac disease . World Journal of Gastroenterol
. 2010 April 28;16(16):1939-1942.
3-Peter H.R. Green , and , Christophe Cellier . Celiac Disease . The New England
Journal of Medicine . 2007 october 25 357 ; 17 .
4- Celiac disease . National Digestive Diseases Information Clearinghouse
5- J. Bai , E. Zeballos, M. Fried, G.R. Corazza , D. Schuppan, M.J.G. Farthing, C. Catassi ,
L. Greco, H. Cohen, J.H. Krabshuis, celiac disease, World Gastroenterology
Organisation Practice Guidelines,2007
6- Celiac disease . National Digestive Diseases Information Clearinghouse
7-D.BRANSKI, A. FASANO, AND R.TRONCONE. LATEST DEVELOPMENTS IN THE
PATHOGENESIS AND TREATMENT OF CELIAC DISEASE. The Journal of Pediatrics ,
September .2006.295-300.
8-Pubmed.gov,[internet].Celiac Disease in Children and Adolesents at Asing Centre in
SaudiArbia,2002,[updated2011Jan.-Feb.]availableat
http://www.ncbi.nlm.nih.gov/pubmed/21245600 .
9-Kirby Sainsbury , Barbara Mullan. Measuring beliefs about gluten free diet adherence in adult
coeliac disease using the theory of planned behavior. Appetite 56 (2011)
10-J. Bai , E. Zeballos, M. Fried, G.R. Corazza , D. Schuppan, M.J.G. Farthing, C. Catassi , L. Greco,
H. Cohen, J.H. Krabshuis, celiac disease, World Gastroenterology Organisation Practice
Guidelines,2007.
476-483.
11-AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac
Disease, gastroenterology,2006 octoper,
131:1977-1980.
12-Marco Silano, Carlo Agostoni ,and Stefano Guandalini . Effect of the timing of gluten
introduction on the development of celiac disease . World Journal of
Gastroenterol . 2010 April 28;16(16):1939-1942.
13-Victorien M. Wolters .Cisca Wijmenga, Genetic Background of Celiac Disease and Its Clinical
Implications Am J Gastroenterol.
2008;103(1):190-195.
14-A.Bellini, C.Zanchi, S.Martelossi, G.Leo, T.Not, and A.Ventura.Compliance with Gluten-free
Diet: The Role of Locus of control in Celiac Disease.The Journal of Pediatrics.463-466
15-A.Fasano.Surprises trom Celiac Disease. SCIENTIFIC AMERICAN, INC.2011,2009.
16- Pubmed.gov,[internet].Celiac Disease in Children and Adolesents at Asing Centre in
SaudiArbia,2002,[updated2011Jan.-Feb.]availableat
17- Kirby Sainsbury , Barbara Mullan. Measuring beliefs about gluten free diet adherence in adult
coeliac disease using the theory of planned behavior. Appetite 56 (2011) 476-483.
http://www.ncbi.nlm.nih.gov/pubmed/21245600