Celiac Disease

Clarifying What is Celiac Disease

When you have Celiac Disease and ingest gluten, your body initiates an immune response that directly attacks your small intestine, particularly the villi. The villi are crucial aspects of the small intestine’s lining, which help absorb nutrients. When these are damaged, your body struggles to assimilate nutrients, potentially leading to malnutrition.

The Pathophysiology of Celiac Disease

The intricate workings of Celiac Disease revolve around the body’s immune response to gluten. It's crucial to understand that this isn't a food allergy but an autoimmune disorder. Below is a summary of how Celiac Disease unfolds:

The autoimmune response also releases specific antibodies. Medically, these are known as anti-gliadin, anti-endomysium, and anti-tissue transglutaminase antibodies, and are currently crucial factors for diagnosing Celiac Disease.

Pathophysiology Stages Details Stage 1 - Immune Activation The immune response in Celiac Disease is triggered when the digestive enzymes breakdown gluten proteins into proline-rich gluten fragments. Stage 2 - Inflammation and Injury The immune response leads to inflammation and injury of the small intestine's lining. This is why patients often undergo endoscopy for testing. Stage 3 - Malnutrition As this cycle continues over time, the villi in the small intestine become damaged or flattened which can lead to malnutrition.

In the absence of corrective measures such as a strict gluten-free diet, Celiac Disease can lead to long-term complications like nutritional deficiencies, osteoporosis, infertility, other autoimmune disorders and even some forms of cancer.

Recognising Celiac Disease Symptoms

Celiac Disease symptoms manifest differently and vary widely among patients. Some may experience severe symptoms while others are asymptomatic (do not show any symptoms). Being knowledgeable about these symptoms helps make timely diagnoses and begin suitable treatment plans at the earliest possible time.

Common Celiac Disease Symptoms

• Diarrhoea: Frequent, watery stools are commonly observed due to the malabsorption of nutrients.
• Weight loss: Unexplained weight loss can occur when your body is unable to properly absorb the nutrients it needs.
• Bloating and gas: Inflammation of your intestinal tract can lead to bloating and gas.
• Fatigue: With malnutrition, your body can't get the nutrients necessary for energy, leading to fatigue.
• Constipation: While diarrhoea is more common, some people may experience constipation.
• Nausea and vomiting: These can occur due to irritation of your gut lining.

Other common symptoms include abdominal pain and cramping, the sensation of a full stomach, anaemia due to poor iron absorption, and skin rashes (dermatitis herpetiformis).

Less Typical Celiac Disease Symptoms

Less common symptoms of Celiac Disease aren't directly related to digestion and can affect other systems in the body.

• Mouth ulcers and dental enamel defects: These can be due to poor absorption of essential vitamins and minerals.
• Joint and bone pain: This may be due to poor absorption of calcium and vitamin D.
• Delayed growth in children: Poor nutrition can slow down growth and development.
• Neurological issues: These can include migraines, seizures, or peripheral neuropathy (tingling and numbness in the hands and feet).

It's important to note that symptoms can differ significantly from one patient to another, making Celiac Disease a complex ailment to diagnose. Other less common symptoms include osteoporosis, infertility, liver disorders, depression and anxiety.

Testing for Celiac Disease

If you suspect Celiac Disease, conducting tests is the first step in confirming the diagnosis. These tests discern the condition and distinguish it from other disorders with similar symptoms, such as irritable bowel syndrome or lactose intolerance. Here's what you need to know about the Celiac Disease testing process.

The Celiac Disease Test Process

Diagnosing Celiac Disease involves a combination of blood tests and an endoscopy to examine the small intestine. First, a serology blood test is performed to detect specific antibodies.

It typically checks for the presence of the following antibodies:

• Anti-tissue transglutaminase (tTG) antibodies
• Endomysial antibodies (EMA)
• Deamidated gliadin peptide (DGP) antibodies

In addition to blood tests, a biopsy of the small intestine is often performed to affirm the diagnosis. Here, several small tissue samples are taken from the small intestine to check for signs of its damage – villous atrophy – indicative of Celiac Disease.

Interpreting Celiac Disease Test Results

Detecting Celiac Disease is facilitated by understanding how to interpret the test results. Abnormally high levels of particular antibodies coupled with biopsy results can provide a clear indication of the condition.

Test Indication Anti-tTG and EMA antibodies Elevated levels are strong indicators of Celiac Disease. DGP antibodies High levels of DGP antibodies can manifest in some individuals with Celiac Disease, particularly children. Biopsy showing villous atrophy This validates the diagnosis. Villous atrophy involves the flattening of the villi, compromising the small intestine’s ability to absorb nutrients effectively.

However, it's important to remember that these tests aren't always definitive — especially for those who are already following a gluten-free diet. Because the tests look for an immune response to gluten, those avoiding this protein might receive negative test results even if they have the disease. Hence, it's advised not to start a gluten-free diet until after the diagnostic process is complete.

Dealing with Celiac Disease

If you or one of your patients has been diagnosed with Celiac Disease, you might wonder what the next steps are. Luckily, with effective treatment approaches, it's entirely possible to manage Celiac Disease successfully and live a healthy life. From adhering to a strict gluten-free diet to exploring modern medications, you have several options to tackle this autoimmune disorder effectively.

Celiac Disease Treatment Approaches

The primary approach to treating Celiac Disease involves creating a dedicated, lifelong diet plan to avoid all sources of gluten. There is currently no cure for the condition, but following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

In addition to wheat, barley and rye, gluten can also be hidden in products such as soup, sauce mixes, processed foods, and even medications. Therefore, it's essential to check the ingredient lists of all packaged foods and eliminate any containing gluten. Foods naturally free from gluten include:

• Fruits and vegetables
• Meat and fish
• Dairy
• Beans, legumes, and nuts
• Most types of rice
• Gluten-free grains like quinoa, flax, and chia

Compliance to a gluten-free diet can help reduce inflammation in the affected section of the intestine, leading to symptom alleviation and repair of the intestinal lining over time. However, changes are not instantaneous, and it might take 6 months to 1 year for the intestine to heal after starting a gluten-free diet.

Available Celiac Disease Medication

Although not the first line of treatment, these medications can have a complementary role, particularly in patients who fail to respond to dietary changes. They include:

• Steroids: Corticosteroids may be prescribed in severe cases to reduce inflammation.
• Immunosuppressants: For people whose bodies are not responding well to dietary changes alone, immune system suppressors like azathioprine (Imuran) might be prescribed.
• Dietary Supplements: Nutritional supplements might be used to replace deficiencies in such nutrients as iron, calcium, magnesium, zinc, vitamin D, and other B vitamins.
• Enzyme Treatments: Research is under works for medications that can help the body tolerate gluten.

It's important to emphasise that medication should not replace a gluten-free diet, but rather supplement it where required. The combination of diet vigilance and supportive care can aid in reducing symptoms, treating deficiencies and mucosal healing for individuals dealing with Celiac Disease.

Celiac Disease in the Nursing Context

In the nursing context, understanding Celiac Disease and the associated challenges that patients face is crucial. From recognising symptoms to ensuring dietary compliance, your role as a nurse can significantly impact patient health outcomes.

Providing Celiac Disease Nursing Care

Providing care to a patient with Celiac Disease goes beyond usual nursing duties. It encompasses empathetic understanding, educating the patient about the disease, and assisting with administering effective management plans.

To deliver optimal nursing care, you should:

• Educate the patient: It's vital to ensure that the patient understands the disease, the nature of its lifelong commitment, and the reasons behind dietary restrictions. This helps set realistic expectations and promotes adherence to the gluten-free diet.
• Assist in dietary planning: From hospitals to home, maintaining a gluten-free diet can be challenging. Assisting with meal planning, advising on nutritious choices, and suggesting alternatives can be immensely helpful.
• Monitor symptoms: Keep a close eye on symptoms and report any changes to the medical team. Monitoring helps in the early detection of potential complications and reassesses response to treatment.
• Support and encouragement: Living with Celiac Disease is a considerable adjustment. Providing emotional support, encouragement, and reassurance can significantly impact a patient's morale and their ability to cope with the disease.

The Nurse's Role in Managing Celiac Disease

The role of a nurse in managing a chronic condition such as Celiac Disease is both varied and vital. You are a central figure in patient care, facilitating communication between the patient and healthcare team, and providing consistent care and support.

Your roles include:

• Disease Education: Clarify misconceptions, inform about the disease process, the importance of a gluten-free diet, symptoms of gluten exposure, and potential complications. This will empower the patient to make informed decisions about their health.
• Monitoring and Evaluation: Regularly assess the patient's overall health, adherence to the diet, and tolerance to the regime. Keep an eye for potential nutrient deficiencies or any dietary-related problems.
• Supporting Dietary Changes: Assist in planning a gluten-free diet, provide resources for gluten-free products, recommend potential dietitians, and work with catering services, if required, at hospitals or nursing homes.
• Psychosocial Support: Recognise and attend to emotional or psychological struggles. Connecting patients with support groups or professional psychological help can positively influence their coping skills.

Celiac Disease: Practical Tips for Nurses

By implementing a few practical measures, nurses can enhance the quality of care for patients with Celiac Disease.

• Get familiar with gluten-free diets: Familiarise yourself with what a gluten-free diet entails. This helps in assisting patients with their meals, checking for hidden sources of gluten in hospital meals or advising on safe choices. Staying updated with newer gluten-free products can also benefit your patients.
• Awareness about cross-contamination: Cross-contamination is a significant issue for patients with Celiac Disease. From kitchen spaces to cooking utensils, unseen gluten contamination can cause symptoms. Educate your patients and their caregivers about this risk.
• Recognise the psychological impact: Living with a chronic disease can be emotionally taxing. The psychological impact Celiac Disease can carry is often overlooked. Recognise it, support your patients, and refer them for counselling if needed.
• Stay updated: As Celiac Disease is a continually evolving field, staying updated with the recent advances can help you provide quality care to your patients.

Remember, your care can significantly impact how your patients adjust to their new lifestyle. Your support, knowledge, and understanding can guide them through their Celiac Disease journey, promoting better health outcomes and improved quality of life.