Celiac disease By Lugansk State Medical University

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The Lugansk medical University activities cover a wide range of subjects, all aimed at shaping a global University policy. Thus, educational policy, quality assurance, University management, legislation and international contacts all fall within the scope of the University's competence. Lugansk State Medical University constantly keeps in touch with its graduates: Many of them have become highly qualified doctors, known scientists, health service managers and political figures in their mother countries.

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Celiac disease By Lugansk State Medical University

  1. 1. Celiac Disease in women Lugansk State Medical University Block 50 years, Of lugansk defence, 1. Lugansk - 91045, Ukraine. email : info@lsmuedu.com / kanc@lsmuedu.com Official  website - http://www.lsmuedu.com +38-091-9484-428
  2. 2. Learning ObjectivesAt the end of this presentation you should:1-Enumerate the problems a woman affected with celiac disease may encounter during her life2-Be aware of the methods of diagnosis of celiac disease3-Describe effective control for the disease to minimize symptoms and long term sequelae of the disease
  3. 3. Magnitude of the Problem of Celiac DiseaseCeliac disease is an autoimmune disease affecting the smallintestine. Various studies have shown its association withother autoimmune endocrinologic disorders affecting differentorgans -systems- of the body such as diabetes, thyroiddisorders and infertility. In fact 50% of patients affected withceliac disease have atypical presentations not involving theGIT and consequently, many celiacs are expected to seeksmedical advice from specialists other than gastroenterologists.We, as Ob/Gyns, should be aware of the differentpresentations of the disease that we may encounter at theoffice.
  4. 4. Definition• 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.
  5. 5. IncidenceThe incidence of Celiac disease varies between 1-100 to 1-300in the general population according to geographicaldistribution. Generally speaking, celiac disease is morecommon in women than men. This high incidence can beexplained by the fact that women are more keen about theirhealth compared to males and therefore, they seek earlymedical advise. The high incidence of the disease in womencan be just a simple reflection of this behavior.
  6. 6. Incidence (Cont.)The incidence of celiac disease varies among specific groups.It ranges between 4-8% among women diagnosed withunexplained infertility. About 6% of anemic women haveundiagnosed celiac disease. A recent study suggested that3-4% of women who have osteoporosis have celiac disease.
  7. 7. Effect on Menstruation1- Amenorrhea is a possibility2-Short fertile period: affected women have late menarche and early menopause
  8. 8. Effect on pregnancy and lactation1-Iron deficiency anemia: due to a-Malabsorption of dietary iron b-Occult blood loss from gastro-intestinal tract2-Poor absorption of folic acid leading to recurrent miscarriages and increased theoretical risk of of neural tube defects in babies of affected mother
  9. 9. Effect on pregnancy and lactation3-Increased incidence of IUGR and low birth weight babies4-Higher incidence of preterm birth and Cesarean sections among affected mothers5-Shorter duration of breast feeding
  10. 10. Effect on Fertility1- Unexplained infertility2-Recurrent miscarriages3-Poor quality seminal fluid was detected in males affected with celiac disease
  11. 11. 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.
  12. 12. Complications1-Malignancies: lymphoma of the small intestine, non Hodgkin’s lymphoma, Cancer of the pharynx, oesophagus and small intestine are all well recognized in association with celiac disease.2-Osteoporosis3- Bleeding tendency4-Refractory celiac disease: in longstanding cases not on; or not responding to, free gluten diet
  13. 13. DiagnosisI- Symptoms include:• 50% of patients show the classic form of the disease of chronic diarrhoea, nausea, vomiting, flatulence, bloating, abdominal pain and weight loss. Fatigue, weakness and lethargy are also common associated symptoms.• Many affected adults lack GI symptoms & present with a wide spectrum of manifestations such as insulin-dependent diabetes, joint pains, osteoporosis, iron, folate, B12 deficiency, depression, dermatitis herpetiformis & infertility
  14. 14. Diagnosis (Cont.)II-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)
  15. 15. Diagnosis (Cont.)III-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.
  16. 16. Diagnosis (Cont.)IV-Prothrombin time and partial thromboplastin time: useful to identify deficiency of vitamin K, which predisposes patients to hemorrhageV-Radiology: has no role in the diagnosis of celiac disease. However, it can help rule out other pathologies of gastro- intestinal disease.
  17. 17. Treatment1-The standard treatment is gluten free diet for life. It is essential to relieve symptoms and avoid long term complications of the disease. Avoid all foods made from wheat, rye, and barley.Examples are:-Breads, cereals, pasta, cakes and cookies-Sausages, processed and canned meats-Yogurt, ketchup and mustard-Candy bars and ice cream
  18. 18. Treatment (Cont.)2-Avoid medications and vitamin preparations which contain gluten.3-Steroids or immunosuppressants in refractory cases4- Supplemental iron, folate, B12, calcium and magnesium.
  19. 19. LUGANSK STATE MEDICAL UNIVERSITY Lugansk State Medical University Block 50 years, Of lugansk defence, 1. Lugansk - 91045, Ukraine. email : info@lsmuedu.com / kanc@lsmuedu.com Official  website - http://www.lsmuedu.com +38-091-9484-428

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