Celiac Disease in women

Posted by e-Medical PPT Sunday, March 18, 2012
Celiac disease is a life long autoimmune enteropathy affecting small intestine characterized by a permanent intolerance to dietary gluten. Gluten is a protein found in the cereal grains of wheat, rye, barley & oats.

In affected individuals, ingested gluten causes inflammation and damage to the small bowel. This damage impairs the normal absorption of food leading to nutritional deficiencies and therefore, can affect the body in many different ways.

Effect on Menstruation
1- Amenorrhea is a possibility
2-Short fertile period: affected women have late menarche and early menopause

Effect on pregnancy and lactation
1-Iron deficiency anemia: due to
    a-Malabsorption of dietary iron
    b-Occult blood loss from gastro-intestinal tract

2-Poor absorption of folic acid leading to recurrent miscarriages and increased theoretical risk of of neural tube defects in babies of affected mother
3-Increased incidence of IUGR and low birth weight babies
4-Higher incidence of preterm birth and Cesarean sections among affected mothers
5-Shorter duration of breast feeding

Effect on Fertility
1- Unexplained infertility
2-Recurrent miscarriages
3-Poor quality seminal fluid was detected in males affected with celiac disease

Effect on bone mineral density
Celiac disease decreases bone mineral density in affected women. The underlying mechanism is related to calcium malabsorption and subsequent increase in parathormone secretion by the parathyroid which, in turn, increases bone turnover.
Treatment with vitamin D may be required in the presence of osteomalacia. 

Diagnosis
Serology: tests are used to measure antibodies formed against the breakdown products of ingested glutens and the enzymes that mediate the tissue damage in the disease. Because of their high sensitivity, they are used for screening. They also can be used to monitor response of patients on strict gluen diet.

1-Antigliadin antibodies (AGA)
2-Anti-tissue antibodies (tTGA)
3-Antiendomysial antibodies (EMA)

The gold standard diagnostic test is endoscopic biopsy of the upper small bowel. Because of the invasive nature of this, it should be reserved only for those with positive screening serology tests. However, A negative test may still prompt a biopsy if the clinical suspicion is high. 4-8 biopsies should be obtained for diagnosis from either the distal duodenum or the proximal jejunum.

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