• Coeliac disease is a genetically-determined chronic inflammatory intestinal disease induced by an environmental precipitant, gluten. • Patients with the disease might have mainly non-gastrointestinal symptoms, and as a result patients present to various medical practitioners. • Epidemiological studies have shown that coeliac disease is very common and affects about one in 250 people. • The disease is associated with an increased rate of osteoporosis, autoimmune diseases, and malignant disease, especially lymphomas. • The mechanism of the intestinal immune-mediated response is not completely clear, but involves an HLA-DQ2 or HLA-DQ8 restricted T-cell immune reaction in the lamina propria as well as an immune reaction in the intestinal epithelium.

1. presented By:Evana AL Youssef Supervisor: Dr.Sana Janakat 14-12-2011 Celiac Disease Jordan University of Science and Technology Faculty of Agriculture Department of Nutrition and Food science

5. Celiac Disease −Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.

8. What are symptoms of CD:

9. Small Intestine villi: Absorption Normal villi Flattened villi Malabsorption

10. Celiac Disease − Pathophysiology (Adapted from Bray GA. Gray DS, Obesity, part 1: Pathogenisis. West J Med 149:429, 1988; and Lew EA, Garfinkle L; Variations in mortality by weight among 750,000 men and women. J Clin Epidemiol 32:563, 1979.) Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.

13. Mechanisms:

14. Mechanism:

17. Dermatitis Herpetiformis:

21. Serology Tests Kind subscription Anti-tissue transglutaminase antibody (tTG – IgA and IgG) most sensitive Anti-endomysial antibody (EMA-IgA highly specific marker Anti-deaminated gliadin peptide (DGP – IgA and IgG) (-) tTG or EMA OR IgA deficient Anti-gliadin antibody (AgA – IgG and IgA) used for children < 2 yr

22. Endoscopic and biopsy findings in patients with and without celiac disease Normal small intestine Celiac Disease Normal villi Villous atrophy

23. Normal Human Duodenal Mucosa (A) and Peroral Small Bowel Biopsy Specimen (B) from a Patient with Gluten Enteropathy (From Floch MH. Nutrition and Diet Therapy in Gastrointestinal Disease. New York: Menum Medical Book Co., 1981)

24. Diagnostic:

31. Celiac Disease − Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.

37. Thanks For listening: