Celiac disease

Clinic

• Coeliac / Celiac disease is a long-term autoimmune disorder, primarily affecting small intestine
• Individuals develop intolerance to gluten foods ( wheat, rye, barley)
• Classic symptoms include GI problems such as chronic diarrhoea, abdominal distention, malabsorption, loss of appetite, and failure to grow.
• It is associated with other autoimmune diseases, such as Type 1 diabetes mellitus and Hashimoto's thyroiditis.

Signs / Symptoms

• Malabsorption: Pale, loose, or greasy stools (Steatorrhoea), which leads Weight loss / Failure to gain weight / Fatigue / Anemia / Low bone mass
• Asymptomatic 43%
• Characteristic Diarrhoea : Chronic, Pale, Large volume, Offensive
• Abdominal pain, cramping, bloating + abdominal distension (Fermentation production of bowel gas)
• Mouth ulcers

3 Related disease

• IgA deficiency
• Dermatitis herpetiformis
• Hyposplenism (a small and underactive spleen)
• Type 1 Diabetes mellitus
• Hashimoto's thyroiditis
• Microscopic colitis
• Gluten ataxia
• Psoriasis
• Vitiligo
• Autoimmune hepatitis
• Primary sclerosing cholangitis, Primary biliary cholangitis
• IBS
• Opsoclonus
• Adenocarcinoma / Lymphoma of small bowel
• Enteropathy-associated T-cell lymphoma (EATL)
• Other non-Hodgkin lymphomas

4 Entities

• I find a specific relationship between two different disease Opsoclonus and Celiac disease.

• The question is "What can relate this two?"I guess a Possible causative virus. So I search for a common viral miasm which could Cerebral Ataxia, which is the underlying entity of Opsoclonus and Gasteroentritis which is possibly the underlying entity of Celiac.
• Another entity is Protein losing entropathy
• By crossing these two, I find only CXA and CXB virus.

• Surprisingly CXB is related to Type 1 Diabetes mellitus and also mouth ulceration and Hashimoto thyroiditis.
• CXA, CXB covers spelenomegaly, Hepatitis
• So I suggest these two entities:
  • Cerebellar Ataxia
  • Gastroenteritis

Celiac vs IBD

• The etiology and immunopathogenesis of both conditions characterized by chronic intestinal inflammation,
• Both are complex diseases with genetics and environment contributing to dysregulation of innate and adaptive immune responses, leading to chronic inflammation and disease.
• CeD constitutes a particular disease because the main environmental and genetic triggers are largely known.
• IBD comprises two main clinical forms, Crohn’s disease and ulcerative colitis, which most likely involve a complex interplay between some components of the commensal microbiota and other environmental factors in their origin. These multifactorial diseases encompass a broad spectrum of clinical phenotypes and ages of onset, although the clinical presentation often differs depending on childhood or adult onset, with greater heterogeneity commonly observed in adults.
• Celiac has Diarrhea + Abdominal distension / pain + Constipation + Dyspepsia + Recurrent vomiting + Pyrosis and regurgitation + IBS with diarrhea predominance while IBD has Diarrhea (± rectorrhagia) Abdominal pain (less predominant in UC)
• Both Celiac and IBD have Protein losing enteropathy endued mal absobtion sign / Symptoms including
  • Refractory iron-deficiency anemia
  • Short stature Failure to thrive

Special accompanied entities

IBD	Celiac
Weight loss (less prevalent and extreme in UC) Sexual maturation delay Pneumopathies Psychological syndromes Arthritis and arthralgias (the most common in both CD and UC) Ocular: acute episcleritis, uveitis, orbital myositis Skin: Erythema nodosum, pyoderma gangrenosum Hepatobiliary system: primary sclerosing cholangitis (less predominant in CD), autoimmune hepatitis (unusual) Renal system: ureteral obstruction, hydronephrosis, urinary stones Vascular system: thrombocytosis, hyperfibrinogenemia, elevated factor V–VII, Depression antithrombin III Bone: osteoporosis (less predominant in UC)	Dermatitis herpetiformis Vitamin B12 deficiency Neurological symptoms Menstrual disturbances Bleeding diathesis (malabsorption of vitamin K) Paresthesia, cramps and tetany (hypocalcemia) Hepatobiliary system: LFT rising Osteopenia, osteomalacia and osteoporosis Edema, ascites and anasarca (hypoproteinemia) Hypopituitarism and adrenal insufficiency Recurrent mouth ulcers
HSV-1, EBV, MTB