CELIAC DISEASEDiagnostic Image Compendium

Presented by Gutsy Overu

BIOL 218 Human

Anatomy

INTRODUCTION

The purpose of this compendium is to explain what celiac disease is and to illustrate normal vs. pathological intestines and villi

Celiac disease is an inflammatory condition of the small intestine, induced by gluten

Gluten is the term for the storage proteins of wheat. The alcohol-soluble fraction, called gliadin, has been most studied, but most of all gluten proteins are likely to be toxic in celiac disease

Celiac disease is very common, one of the most common inherited diseases that physicians can encounter. Originally considered to be a rare disease of childhood, it is now recognized predominantly as a disease of adults

Overall, it is considered to occur in about 1 per 250 individuals. Most recent figures are 1 per 133 in USA, 1 per 122 in Northern Ireland, 1 per 99 Finnish school children and 1 per 100 in western England, which indicate it occurs in about 0.5 to 1% of those of European descent

There are other factors apart from gluten that can contribute to the development of celiac disease. Some of the factors are the timing of the first ingestion of gluten in childhood and the amount of gluten, whether breast feeding occurs and whether other members of the family have celiac disease. Smoking also influences the onset of celiac disease.

WHAT IS CELIAC DISEASE?

What is celiac disease?

Celiac disease is an

inflammatory condition of

the small intestine, induced by

gluten. It has diverse clinical

manifestations that resemble a

multi-systemic disorder rather

than a primary intestinal

disease. Originally considered

a rare disease of childhood,

celiac disease is, however,

now recognized as a common

condition that may be

diagnosed at any age. Other

terms for celiac disease

include gluten sensitive

enteropathy and non-tropical

sprue.

http://3.bp.blogspot.com/_PC3aIMjVWm8/SRVtnmHBGII/AA

AAAAAAAso/EC-dMr7gTcs/s400/villi.jpg

SYMPTOMSClinical Presentation

The clinical manifestations of celiac disease vary

markedly by the age of the patient, the duration

and extent of disease, and the presence of

extraintestinal pathology (TABLE 2).1

Depending on the features at the time of

presentation and taking into account the

histological and immunologic abnormalities at

the time of diagnosis, celiac disease can be

divided into the following three clinical forms:

classic (typical), atypical, and silent

(asymptomatic).1

Significance of celiac disease

Symptomatic celiac disease is associated with a

considerable amount of illness and morbidity due

to chronic gastrointestinal symptoms and

malabsorption of nutrients, weight loss,

metabolic bone disease, anemia and general

debility. Celiac disease results in an increased risk

of the development of various malignancies

including lymphoma at any site, not only the

small intestine.http://www.uspharmacist.com/CMSImagesContent/20

08/12/USP0812%20Celiac%20T2.jpg

VILLI DAMAGE

This figure illustrated the progression of

destruction to the intestinal villi by gluten.

When a person with celiac disease

consumes foods or uses produces that

contain gluten, his or her immune system

reacts by damaging the small intestine and

the minute, fingerlike protrusions that line

the small intestine, called villi, are

damaged or destroyed. Normally villi

permit nutrients from food to be absorbed

into the bloodstream. If the villi are not

healthy or have been destroyed, a person

become malnourished regardless of the

quantity of food eaten. This villi damage

can also lead to lactose intolerance.

http://www.my-health-and-wellness-

coach.com/images/villi.JPG

ENDOSCOPY

Endoscopic and biopsy findings in patients

with and without celiac disease. (A) High-

definition endoscopic photo of normal small

intestine. The villi are clearly visible with no

evidence of atrophy or scalloping of the

folds. (B) Biopsy specimen of normal small

intestine (hematoxylin-eosin; original

magnification, × 100). (C) PillCam image of

small intestine in a patient with celiac

disease, showing scalloping of the mucosal

folds (arrows) characteristic of a

malabsorption pattern. There is also

evidence of villous atrophy compared with

normal. (D) Biopsy specimen of small

intestine in a patient with celiac disease

(hematoxylin-eosin; original magnification,

× 100). Note the loss of villous architecture.

http://www.aafp.org/afp/20071215/af

p20071215p1795-u3.jpg

MUCOSAL BIOPSY

Small-intestinal mucosal biopsy.

(A and B) Small-intestinal mucosal biopsy viewed through a dissecting microscope. The normal biopsy

(A) shows numerous surface villi, whereas a biopsy from an individual with CD and total villous atrophy

shows, in place of the villi, numerous surface openings to underlying crypts and surface ridges (B). (C)

H&E-stained section of a normal small-intestinal mucosal biopsy. Original magnification, ×400. (D)

H&E-stained section of a small-intestinal mucosal biopsy from an individual with CD and total villous

atrophy. Original magnification, ×400. All panels reprinted with from Gastroenterology (1) with permission

from the American Gastroenterological Association.

http://www.jci.org/articles/view/30253/files/JCI0730253.f1/medium

BIOPSY

http://depts.washington.edu/drrpt/2

003/stories/researchpics/villi.jpg

The diagnosis of celiac disease

requires finding characteristic changes

in a small intestinal biopsy, together

with clinical and/or histologic

improvement on a gluten-free diet

.Biopsy is recommended to establish

the diagnosis because the blood tests

only suggest the presence of the

disease. In addition, the disease is life

long. Diagnosis requires the patient to

adhere to the diet throughout their

life. While it may not easy to control a

small child’s diet, as they grow older

they need to understand the disease,

believe they do have the disease and

treat it themselves. Documentation of

the disease by biopsy reinforces the

diagnosis. Studies have shown

adherence to the diet is greatest in

those who underwent biopsy

TISSUE STAIN

Figure 1.

Microscope views of tissues

taken from the small intestine

by biopsy. At left are normal

villi (fingerlike projections

extending from the surface).

Figure 2.

At right, in tissue from a

celiac patient, the villi have

flattened and disappeared.

http://z.about.com/d/celiac

disease/1/0/0/-/-/-

/VilliAtrophy.jpgFigure 1. Figure. 2

WHERE DO WE FIND GLUTEN?

http://www.isletsofhope.com/pic/ZZPic%2

0celiac-sprue-foods-to-avoid.jpg

CONCLUSIONS

Adherence to a gluten-free diet remains the mainstay of therapy for celiac disease.

Although a gluten-free diet seems simple theoretically, the diet can be difficult for some patients to adhere to. The most common reasons for lack of response are poor compliance and inadvertent gluten ingestion.

All patients with celiac disease should be reevaluated periodically. The evaluation should include assessment of growth, assessment of GI and other symptoms associated with celiac disease, and the individual patient's understanding of and compliance with the gluten free-diet.

The most useful website for correct and through information pertaining to this disease: http://www.uspharmacist.com/CMSImagesContent/2008/12/USP0812%20Celiac%20T2.jpg

A follow up compendium that would add to the understanding of celiac disease would be research on various other autoimmune diseases.

REFERENCES Slide 3- Diagram of intestinal villi

http://3.bp.blogspot.com/_PC3aIMjVWm8/SRVtnmHBGII/AAAAAAAAAso/EC-dMr7gTcs/s400/villi.jpg

Slide 4- Symptoms chart

http://www.uspharmacist.com/CMSImagesContent/2008/12/USP0812%20Celiac%20T2.jpg

Slide 5- Villi Damage

http://www.my-health-and-wellness-coach.com/images/villi.JPG

Slide- 6- Endoscopy

http://www.aafp.org/afp/20071215/afp20071215p1795-u3.jpg

Slide 7- Small intestine mucosal biopsy

http://www.jci.org/articles/view/30253/files/JCI0730253.f1/medium

Slide 8- Biopsy of intestinal villi

http://depts.washington.edu/drrpt/2003/stories/researchpics/villi.jpg

Slide 9- Histological slide of villi

http://z.about.com/d/celiacdisease/1/0/0/-/-/-/VilliAtrophy.jpg

Slide 10- Where is Gluten?

http://www.isletsofhope.com/pic/ZZPic%20celiac-sprue-foods-to-avoid.jpg