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COELIAC DISEASE


Defination=a chronic intestinal disease producing malabsorptn nd caused by intolerance to gluten,characterised by immune mediated enteropathy ,nd improve after withdrawl of gluten.
ETIOLOGY= 1.Immunological damage to mucosa due to gluten protein of wheat.Toxic component in gluten is gliadin
2.High assoc with HLA DQ2
Pathology=1.Mucosa of duodenojejunal flexure shows partial villous atrophy or subtotal villous atrophy.
2. Lamina propria demonstrate cellular infiltrates of plasma cells nd lymphocytes.
CLINICAL features=
1.Range frm mild anemia to florid malabsorption.Most common coz of anemia is iron def,it may b due to folate nd vit.B12 defi.
2.Diarrhoea ,weight loss
3.Peripheral neuropathy,hypoproteinemia,oedema,bone pain ,tetany
4..Features of vitamin defi
5..Clubbing,glossitis,angular stomatitis,skin pigmentatn
6..Amenorrhoea ,infertility
7..Other autoimmune disease assoc with coeliac disease r type 1 diabetes,rheumatoid arthritis,SLE,Addison disease
8..Other extraintestinal fetures include IgA nephropathy,elevated liver enzymes nd liver failure,myocarditis

Complication=
1..Dermatitis herpetiformis
2..Intestinal lymphoma involving jejunum
3..Peripheral neuropathy
4..Epilepsy
5..Osteomalacia
6..Amyloidosis
INVESTIGATIONS=
1..Serologic tests
IgA antiendomysial antibodies
IgG nd IgA antigliadin antibodies
Antitransglutaminase antibodies
2..Abnormal jejunal biopsy
3..Tests indicating malabsorption of proteins,carbohydrate,fat nd vitamins
TEATMENT =
1..Strict gluten free diet,.Avoid wheat nd wheat products,oats,rye nd barley
2..Rice,corn,soyabean,potato,nuts nd beans ,meat r safe
3..Beer must b avoided.Same is true for all kinds of whisky
4..Corticosteroids may given in ill pt who present with acute coeliac crisis with severe diarrhoea,dehydration,weght loss,acidosis,hopocalcaemia
5..Vitamin nd mineral supplemention including iron therapy for anemia
6..Diary products avoided as secondary lactase deficiecy is often assoc with coeliac disease..

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