UNIVERSIDAD NACIONAL DEL NORDESTE

FACULTAD DE MEDICINA - CÁTEDRA INGLÉS II

Nombre: ………………………………………………..…… LU: ……………..……………… Fecha:

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Trabajo Práctico. Simple Past Tense

CELIAC DISEASE

The number of celiac bloggers increases by the day. There are people across the country writing
daily about their experiences with the gluten-free diet. They offer advice for managing celiac, tips
for delicious gluten-free recipes, commentary on new resources and tons of other useful
information. Across the web, celiac and gluten-free bloggers have supported the Beyond Celiac
mission to spread awareness and support for those with the disease.
A. Tori Kenyon
When I was diagnosed in 2009 at the age of 15 with celiac disease, I was told to adhere to a strict,
gluten-free diet and I would be well on my way to feeling great. It’s been 5 years and I find myself
never having found that “I feel great” moment. I am a celiac still struggling, but have learned along
the way that, unfortunately, I am not the only one.
Almost everyone I encountered always said how amazing he or she felt after eating gluten-free
and I couldn’t help but think I was missing something because I didn’t feel amazing, I felt anything
but amazing even with a 100% gluten-free diet. I have struggled with chronic stomach pains,
extreme fatigue, vision blurring, leg and muscle pains, constipation, and the list goes on.
I was not nearly as bad as I was prior to diagnosis but I have reached a point in my life where for
the first time I don’t remember what it felt like before 2009 when I was healthy and could eat
whatever, whenever, and wherever and not think twice. I don’t even expect to feel good after
eating food anymore.
Same old story, going back and forth to doctors’ appointments every 4 months or so,
repeating to my doctor that I still feel lousy, having blood tests run, and nothing
further. I’ve reached a breaking point that I think all those with celiac disease hit at
some point when we just struggle to keep on fighting for our health because day
after day, we just experience the same old pain.
As a college student, I’ve realized my biggest culprit is cross-contamination, as I believe is a culprit
for everyone else still experiencing symptoms. I am now on my own, forced to find food to eat, but
never truly knowing how it was prepared and whether or not after one bite I would be ingesting the
enemy known as “a crumb of gluten.”
An endoscopy in October 2014 revealed my small intestine is just as inflamed as it was when I
was diagnosed; the doctor performing the procedure told my mom that if he had to guess he
would’ve assumed it was my first endoscopy and that I was undiagnosed with celiac disease – but
no, I am 5 years into this disease.
There has been a lot of attention in the media about gluten-free, but never celiac disease. The
disease behind the diet is often pushed to the side, and instead jokes are made and people
assume this fad diet is to lose weight. Cross-contamination is due to a lack of vigilance and
awareness, people not understanding the severity one crumb does to the bodies of those with
celiac disease.
After one crumb is ingested, it takes a minimum of 3-6 months for our intestine to fully heal. That
one crumb is why I am constantly curled up in bed, too sick to move, too weak to exercise, too
lethargic to make it to class some days.
The worst part is that when we are contaminated, our intestine stops absorbing all nutrients, thus,
even eating an apple or banana (naturally gluten-free) leaves me with stomach pain because my
body rejects just about everything. It’s a never-ending cycle that I hope and pray will end soon.
Awareness is needed for the disease behind this diet, specifically a need for vigilance of cross-
contamination across restaurants, schools, college campuses, businesses, and manufacturers. I
am constantly inspired to keep fighting because of the incredible stories shared through these
outlets. The close-knit support from the Celiac Disease Foundation is the reason so many are able
to get through, and I think to have an organization that cares so deeply and reaches out to
members of the community in hopes to raise awareness through personal stories is a blessing,
and makes all the difference in our lives.
The more people share, the more the word gets out. Education is key to help those still struggling,
but it’s so great to know I am not alone in the struggle, as I have read countless stories that mimic
my own.
At 20 years old, I never believed I would be an advocate for something, but I am turning my
struggle into hope for others by reaching out and emphasizing the impact cross-contamination can
have on the life of a celiac; it has certainly changed my life, and I aim to eliminate that one crumb
one day of education at a time.
B. Chad Hines
My story begins at a time when information about celiac disease and eating gluten-free wasn’t at
your fingertips; a time when you couldn’t ask Siri, “what’s celiac?” or “how to eat
gluten-free” and get the answer read to you in your car, while your phone is also
providing you with live traffic and weather updates.
If you’re reading this letter, then you have been affected in some way by celiac
disease and/or a gluten-related disorder. Whether you found Celiac Disease Foundation due to
yourself, a loved one, friend or colleague being diagnosed, I understand what you’ve been going
through.
I’ve always felt that it’s incredibly beneficial to connect with others who share similar experiences.
So today, I’d like to share my diagnosis story with you, with the hope that you’ll join me in helping
to prevent the needless suffering caused by undiagnosed celiac in millions of people in the U.S.
and beyond.
The year was 1988 and I was just five years old. I would wake up every single day with a horrific
headache and agonizing stomach pain. Most days, I would try to work through the pain and go to
school, but there were many mornings where the pain was so severe that I simply couldn’t get out
of bed.
Like most kids, I loved being outdoors and playing sports with friends, but when you’re that age,
it’s hard for your friends to understand that you can’t play baseball or basketball with them
because you aren’t feeling well. Not to mention the fact that I was constantly picked last in sports
due to my small stature, which I would later find out was a result of undiagnosed celiac.
Soon, the head and stomach pain took over my life – school, sports, friends and fun all became
secondary as we desperately tried to figure out what was making me feel so sick. This is when the
seemingly infinite number of doctors’ visits began.
For the next two and a half years, I practically lived in doctors’ offices – something that no child
should ever have to experience. I was put through test after test and ultimately, misdiagnosed at
every turn. The fear of the unknown and frustration that came along with each misdiagnosis began
to take its toll as my health continued to decline.
Finally, after visiting about 20 specialists throughout California and exhausting every resource that
we had, a doctor described the symptoms of something called celiac disease and recommended
that I get tested.
Sure enough, the biopsy results came back and I was diagnosed with celiac disease. Although it
was an exhausting and tiresome process, I was fortunate to get a concrete answer as to why I had
felt so sick for so many years.
And that’s when we met Elaine Monarch, who would forever change my life.
Elaine helped us to understand celiac disease and what it meant to live a healthy gluten-free
lifestyle. Soon after meeting her, Elaine invited my mom and me to attend one of the first ever
Celiac Disease Foundation education conferences, and I was in heaven! My mom focused on all
of the educational aspects and great speakers, while I ran around eating everything in sight! After
all, I had finally found a place where EVERYTHING WAS GLUTEN-FREE! It was truly amazing,
and something that I’ll never forget.
After the diagnosis, and with the help of my family, Elaine and the Foundation, I began to feel
much better and started to feel like a normal, healthy kid again. I then went on to play high school
basketball and water polo and later graduated from USC. Sadly, I lost touch with Elaine
throughout these years.
Post college, I started a few online businesses in the gluten-free space and began to blog about
living gluten-free in hopes that my story might help someone going through similar health issues.
Within a month of launching my first website, I received an email from Elaine that said, “Chad, is
that you after all of these years?”. I was so glad to reconnect with someone who had such a
positive impact on my life.
Elaine then invited me up to the Celiac Disease Foundation offices, where I was eventually asked
to sit on the Board of Directors for the Foundation. Of course, I accepted the invitation with great
enthusiasm. Elaine ’s still the same selfless, caring, and giving person that I remember when I was
so young and I’m privileged to be able to now call this incredible mentor my friend.

A. Tori (T), Chad (Ch) or both (T/Ch) ?

1. Ch chad .was the youngest to be diagnosed
2. Chad ch did not get straightforward diagnosis
3. Chad was given help and advice by a counsellor
4. Chad ch posts diary entries about being a celiac
5. Tory believes that a gluten-free diet and raising consciousness are crucial factors
6. Tory was not able to feel better again
7. Chad was a short kid as a consequence of celiac disease
8. Chad .felt healthy again

B. Say whether the following statements are TRUE (T) or FALSE (F)
1. Ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger
small intestine damage. True
2. Diagnosis is made without delay. False the diagnostic take 15 days
3. Blood tests and an endoscopy are used to test for celiac disease. True
4. In celiac disease, gluten ingestion brings about a reaction from the immune system that
impedes the body to absorb nutrients from food. True
5. People go on a gluten-free diet to lose weight. False
6. A small particle of gluten cannot cause a host of painful reactions. True

C. Pick Regular and Irregular Verbs - in bold type - in the Simple Past tense from the
text to fill in the following table.

Regular verbs Irregular Verbs Negative Forms

encountered became didn’t feel
revealed came cannot
believed took
loved was
tried began

D. Read the following text about Celiac Disease

Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people
where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in
100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for
long-term health complications.
When people with celiac disease eat gluten (a protein found in wheat, oats, rye and barley), their
body mounts an immune response that attacks the small intestine. These attacks lead to damage
on the villi, small fingerlike projections that line the small intestine, that promote nutrient
absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
In children, malabsorption can affect growth and development, in addition to the symptoms seen in
adults.
Who's at Risk?
Celiac disease tends to run in families, as it is a genetic disorder. If you have a parent, child,
brother, or sister who has celiac disease, you have a 1 in 10 chance of getting it yourself. But
having the genes for celiac disease doesn't automatically mean you'll get it.
Sometimes, a stressful event such as a viral infection, surgery, or some emotional trauma can
trigger it. It could also happen after pregnancy. Of course, you would need to be eating foods with
gluten for any harm to happen.
The disease is most common among Caucasians and people who have had other diseases like
Down syndrome, type 1 diabetes, Turner syndrome (a condition where a female is missing an X
chromosome), Addison's disease, or rheumatoid arthritis.
Signs and Symptoms
Mild cases may not cause any noticeable symptoms, and the condition is often only detected
during testing for another condition.
Diarrhoea is the most common symptom of celiac disease. It's caused by the body not being able
to fully absorb nutrients.
Malabsorption can also lead to stools containing abnormally high levels of fat (steatorrhoea).
This can make them foul smelling, greasy and frothy. They may also be difficult to flush down the
toilet.
Other common gut-related symptoms include:
Abdominal pain
Bloating and flatulence 
Indigestion
Constipation
Vomiting (usually only affects children)
And more general symptoms may include: 
Fatigue (extreme tiredness)
Unexpected weight loss
An itchy rash
Tingling and numbness in your hands and feet (peripheral neuropathy)
Disorders that affect co-ordination, balance and speech (ataxia)
Diagnosis
Routine testing for celiac disease isn't recommended unless you have symptoms or an increased
risk of developing them.
Testing for celiac disease involves having:
Blood tests – to help identify people who may have celiac disease
Biopsy – to confirm the diagnosis
A simple blood test is available to screen for celiac disease. People with celiac disease who eat
gluten have higher than normal levels of certain antibodies in their blood. These antibodies are
produced by the immune system because it views gluten (the proteins found in wheat, rye and
barley) as a threat. You must be on a gluten-containing diet for antibody (blood) testing to be
accurate.
The only way to confirm a celiac disease diagnosis is to have an intestinal biopsy. A pathologist
will assign a Modified Marsh Type to the biopsy findings.
The World Gastroenterology Organization recommends pathologists use a modified Marsh
classification for interpretation. Dr. Michael Marsh introduced the classification system in 1992 to
describe the stages of damage in the small intestine as seen under a microscope, also known as
histological changes. Originally the Marsh Types ranged from 0 to 4, with a type of 3 indicating
celiac disease. It has since been simplified to allow for a greater degree of consistency and
reproducibility between pathologists.
Type 0: Intestinal lining is normal -celiac disease highly unlikely
Type 1: Intestinal lining has been infiltrated with IELS – seen in patients on a gluten free diet
(suggesting minimal amounts of gluten or gliadin are being ingested), patients with dermatitis
herpetiformis and family members of celiac disease patients. This may also
indicate gastroduodenits caused by H. pylori, hypersensitvity to food, infectons (viral, parasitc,
bacterial), bacterial overgrowth, pharmacological drugs (mainly NSAIDs), IgA defcit, common
variable immunodefciency or Crohn’s disease.
Type 2: Very rare, seen occasionally in dermatitis herpetiformis.
Type 3: Spectrum of changes seen in symptomatic celiac disease.
Treatment
The only treatment for celiac disease is to follow a gluten-free diet—that is, to avoid all foods that
contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal
damage, and prevent further damage. Improvements begin within weeks of starting the diet.
Although the vast majority of children undergo full healing of their intestinal lining, research has
shown that the healing may remain incomplete in many adults, even though symptoms may
regress.
After treatment with the gluten-free diet, most patients’ small intestines recover and are able to
properly absorb nutrients again. However, patients may continue to be vitamin B deficient as the
gluten-free diet may not provide sufficient supplementation. This can be remedied with a
daily, gluten-free multivitamin.
Medication is not normally required except in some cases of dermatitis herpetiformis, in which
medication such as dapsone or sulfapyridine is administered for a short period of time to control
the rash.
Complications
Because celiac disease is so hard to diagnose, people can have it for years. This long-term
damage to the small intestine may start to affect other parts of the body.
Many of these problems will go away with a gluten-free diet. Your recovery time will depend on
how long you’ve been dealing with the complications. But depending how much damage has been
done, infertility and bone weakness often don’t reverse.
These problems could happen:
Lactose intolerance: The small intestine digests lactose, which is the sugar naturally found in milk.
If your small intestine doesn’t work right because of celiac disease, you might become lactose
intolerant.
Vitamin and mineral deficiencies: When the small intestine is damaged, it can’t absorb vitamins
and minerals. People with untreated celiac disease often are low in these: Iron, Calcium, Fiber,
Zinc, Magnesium, Folate, Niacin, Riboflavin, Vitamin B-12, Vitamin D
Osteopenia and osteoporosis: When your body lacks calcium, your bones can become brittle. If
your small intestine doesn’t heal and you continue to miss out on it, you might develop osteopenia
(low bone density) and then osteoporosis, where your bones are weaker.
Iron deficiency anemia: Your body needs iron to make red blood cells, which carry oxygen around
the body. If you don’t have enough iron and your blood doesn’t have enough oxygen, this can
make you tired and short of breath.
Lymphoma: Celiac disease is an immune system condition, and lymphocytes are part of the
immune system, so it’s possible that a condition like celiac disease could cause cancer in those
cells. Keep in mind that not everyone with celiac disease will get lymphoma. You may be more
likely to get this cancer if you find out you have the condition later in life and have more damage to
your intestines.
Glosario:
barley: cebada fingerlike: digitiforme oats: avena
rye: centeno
small intestine: intestino delgado villi: vellosidades
wheat: trigo

1. Choose the correct option/s to complete each sentence.

a- Patients with celiac disease get the large intestine vili – the small intestine lining–
both the large and small intestines damaged when ingesting gluten.
b- Although celiac disease is a genetic condition, there are a number of factors that can
have a triggering effect. These include: emotional – environmental – congenital –
ethnic – age-related factors among others.
2. In Spanish, make a list of 5 common and 3 general symptoms of celiac disease.
Sintomas generales: fatiga, neuropatía periférica, ataxia.
Sintomas communes: dolor en el abdomen, vomitos, constipacion, diarrea, steatorrea.
3. An early diagnosis of celiac disease can be done thanks to routine testing for the condition
even when the patient is still symptomless. TRUE – FALSE
4. Celiac disease can be identified by means of a blood test because patients show an
increased production of certain antibodies related to gluten ingestion. TRUE – FALSE
5. An intestinal biopsy must be carried out to confirm celiac disease diagnosis based on
intestinal lining damage. TRUE – FALSE
6. All patients following a strict gluten-free diet recover from celiac disease and get intestinal
damage fully healed. TRUE – FALSE
7. Although most symptoms regress when a gluten-free diet is followed, some complications
related to celiac disease may remain. TRUE – FALSE
8. In Spanish, list the possible complications of celiac disease.
Las complicaciones podrian ser
Intolerancia a la lactose.
Deficiencia de minerales y vitaminas.
Anemia por deficiencia de hierro.
Linfoma.
Osteopenia y osteoporosis