INTRODUCTION

 Celiac disease also known as gluten-sensitive enteropathy

 Is a digestive and autoimmune disorder that results in damage
to the lining of the small intestine when foods with gluten are
eaten
 Is the most common genetically related food intolerance,
worldwide.
 Is a multifactorial ,autoimmune disorder that occur in
genetically susceptible individuals
 It is triggered by a well identified environmental factor.
(GLUTEN AND RELATED PROLAMIN PRESENT IN WHEAT,
RYE,AND BARLEY)
EPIDEMIOLOGY
 Globally celiac diseases affects between 1 in 100 and 1in 170 people
 However vary between different regions of the world from as 1 in 300 to as many as 1
in 40
 In the United States it is thought to affect between 1 in 1750 (defined as a clinical
disease including dermatitis herpetiformis with limited digestive tract symptoms) to 1
in 105 ( defined by presence if IgA TG in blood donors)
 However, population studies from part of Europe, India, South America ,Australia, and
USA (using serology and biopsy) indicate that the precentage of people with the
diseasemay be between 0.3 and 1.06% in children (but 5.66% in one study of
children of the predisposed Sahrawi people) and 0.18-1.2% in adults.
 Among those in primary care population who report gastrointestinal symptoms, the
rate of celiac disease is about 3%
MORTALITY AND MORBIDITY
 The morbidity rate of celiac disease can be high
 Its complication range from osteopenia, osteoporosis, or both to infetility in
women, short stature, delayed puberty, anemia and even malignancies
(mostly related to the GI tract). As a result the overall mortality in patients
with untreated celiac disease is increased.
 Evidence also suggests that the risk of mortality is increased in proportion
to the diagnostic delay and clearly depends on the diet
 Person who do not follow a gluten - free diet have an increased risk of
mortality ,as high as 6 times that of the general population
 the increased death rates are most commonly due to intestinal
malignancies that occur within 3years of diagnosis
 SEX AND AGE

 Celiac disease can occur at any stage in life

 A diagnosis is not unsual in people older than 60
years
 Classic GI pediatric cases usually appear in
children aged 9-18 months. Celiac disease may
also occur in adults and is usually precipitated by
an infectious diarrheal episode or other intestinal
disease
PATHOPHYSIOLOGY
CAUSES
 Normally, the body’s immune system is designed to protect it
from foreign invaders
 Your genes combined with eating foods with gluten and other
facotrs can contribute to celiac disease, but the precise cause
isn’t known. Infant feeding practices, gastrointestinal infections
and gut bacteria might contribute as well. Sometimes celiac
disease becomes active after surgery, pregnancy, childbirth,
viral infection or severe emotional stress.
 When the body’s immune system overreacts to gluten in food,
the reaction damages the villi.
RISK FACTORS
Celiac disease tends to be more
common in people who have:
 A family member with celiac
disease or dermatitis
herpetiformis
 Type 1 diabetes
 Down syndrome or Turner
syndrome
 Autoimmune thyroid disease
 Microscopic colitis
 Addison’s Disease
SIGNS AND
SYMPTOMS
 The signs and symptoms of celiac
disease can vary greatly and fiffer in
children and adults. Digestive signs
and symptoms for adults include:
 Diarrhea
 Fatigue
 Weight loss
 Bloating and gas
 Abdominal pain
 Nausea and Vomiting
 Constipation
 However, more than half the adults with celiac
disease have signs and symptoms unrelated to the
digestive system, including:
 Anemia, usually from iron deficiency
 Loss of bone density (osteoporosis) or softening
of bone (osteomalacia)
 Itchy, blistery skin rash (dermatitis herpetiformis)
 Mouth ulcers
 Headaches and fatigue
 Nervous system injury, including numbness and
tingling in the feet and hands, possible problems
with balance, and cognitive impairment
 Joint pain
 Reduced functioning of the spleen
(hyposplenism)
Children with celiac disease
are more likely than adults to
have digestive problems,
including:
 Nausea and vomiting
 Chronic diarrhea
 Swollen belly
 Constipation
 Gas
 Pale, foul-smelling stools
 coordination and seizures
 The inability to absorb nutrients might result in:
 Failure to thrive for infants
 Damage to tooth enamel
 Weight loss
 Anemia
 Irritability
 Short stature
 Delayed puberty
 Neurological symptoms, including
attention-deficit/hyperactivity disorder (ADHD), learning
disabilities, headaches, lack of muscle coordination and
seizures
COMPLICATIONS
MALNUTRITION,BONE WEAKENING,INFERTILITY AND MISCARRIAGE,
LACTOSE INTOLERANCE, CANCER AND NERVOUS SYSTEM PROBLEMS
NONRESPONSIVE CELIAC DISEASE
Some people with celiac disease don’t respond to what they
consider to e a gluten-free diet. Nonresponsive celiac diseae is
often due to contamination of the diet with gluten.
 Bacteria in the small intestine (bacterial overgrowth)
 Microscopic colitis
 Poor pancreas function (pancreatic insufficiency)
 Irritable bowel syndrome
 Difficulty digesting sugar in dairy products( lactose) (sucrose),
or type of sugar found in honey and fruits (fructose)
 Refractory celiac disease
 LABARATORY
AND DIAGNOSIS
 SEROLOGY TESTING : looks
for antiodies in your
blood .Elevated levels of certain
antibody proteins indicate an
immune reaction to gluten
 GENETIC TESTING: for human
leukocyte antigen (HLA-DQ2
and HLA-DQ8) can be used to
rule out celiac disease
 ENDOSCOPY: this test uses a long tube with a tiny camera
that’s put into your mouth and passed down your throat . The
camera enables your doctor to view your small intestine and
take a small tissue sample to analyze for damage to the villi
 CAPSULE ENDOSCOPY: this test uses a tiny wireless
camera to take pictures of your entire small intestine, the
camera sits inside a vitamin -sized capsule ,which you swallow
.As the capsule travels through your digestive tract, the
camera takes thousands of pictures that are transmitted to a
recorder.
 If your doctor suspects you have dermatitis herpetiformis, he
or she might take a small sample of skin tissue to examine
under a microscope
TREATMENT
 Medical care
 total lifelong avoidance of gluten ingestion is the cornerstone treatment
for patients with celiac disease
 Wheat,rye and barley are the grains that contain toxic peptides. They
should be eliminated as completely as possible, although daily intake
doses larger than 10mg are likely needed to cause mucosal reaction.
 GI symptoms in patients with asymmomatic CD who adhere to a gluten-
free diet typically resolve within a few weeks; these patients experience
the normalization of nutritional measures, improved growth in height and
weight and normalization of hematological and biochemical well being.
 Treatment with a gluten free diets reverses the decrease in bone
mineralization and the risk for fractures.
 Lactose is often
eliminated in the
initial phases od
dietary treatment as
well.This is because
lactase deficiency is
thought to
accompany the flat
mucosa.
 MEDICATION

 Glucocorticoids may be needed for

refractory disease
 Corticosteroids can rapidly control
severe symptoms of celiac disease.
They my also have a role in rare
cases in which the patient has no
response to diet;this condition is
known as refractory celiac disease
and occurs exclusively in adults
 For celiac disease in children ,steroids
are almost never needed.
 DIET
 TAKING SUPPLEMENTS
 GLUTEN-FREE DIET
Sometimes people with celiac disease can be deficient in
You’ll need to avoid foods made with wheat and
wheat flour. You also can’t eat foods that contain certain nutrients because their body doesn’t absorb them
any of the following grains because they also properly. The most common include
have gluten in them:  Iron
 RYE
 Calcium
 BARLEY
 Fiber
 DURUM
 Zinc
 FARINA
 MALT
 Vitamin D
 SEMOLINA
 Niacin
 Magnesium
 Folate
 NURSING INTERVENTION
 Monitor dieatary intake, fluid intake and output, weight ,serum electrolytes and hydration status
 Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such
as protein, fats, vitamins and minerals
 Provide parental nutrition as prescribed
 Provide meticulous skin care after each loose stool and apply lubricant to prevent skin
breakdown
 Enocurage small frequent meals, but do not force eating if the child has anorexia
 Use meticulous hand washing technique and other procedures to prevent transmission of
infection
 Assess for fever cough, irritability or other signs of infection
 Teach parents to develop awareness of the childs condition and behavior recognize changes
and care for child accordingly
THANK YOU