Understanding Celiac Disease Reactions: Symptoms & Impact
Celiac disease is an immune-mediated enteropathy triggered by gluten (wheat, barley, rye) in genetically susceptible individuals (HLA-DQ2/DQ8).
Mechanism
Gluten peptides → tissue transglutaminase (tTG) deamidation → presented by HLA-DQ2/8 → T-cell activation → cytokine release → villous atrophy, crypt hyperplasia.
Symptoms (Highly Variable)
- GI: diarrhea, steatorrhea, bloating, pain, nausea, constipation.
- Extra-intestinal: anemia (iron, folate, B12), fatigue, osteoporosis, dermatitis herpetiformis (itchy vesicular rash), neurological (ataxia, neuropathy), infertility, recurrent aphthous ulcers, dental enamel defects.
- Pediatric: failure to thrive, irritability, delayed puberty, short stature.
Associated Conditions
- Type 1 diabetes, autoimmune thyroiditis, Sjögren's, microscopic colitis, IgA deficiency.
Diagnosis
- Serology: tTG-IgA (sensitivity ~98%, specificity ~95%) + total IgA.
- Confirmatory: duodenal biopsies (Marsh classification) on gluten-containing diet.
Treatment
Strict, lifelong gluten-free diet (<20 ppm gluten). Mucosal healing in months–years. Follow-up serology, bone density, nutrient monitoring.
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