• 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.
• 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.
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Chronic Liver Disease in pediatric: a case presentation and discussionDr Abdalla M. Gamal
A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
The tutorial was a joint effort between Dr Zeinab Salem Ali (from Pediatric Department) and me (from Radiology Department). In her slides, Dr Zeinab presented the case history, examination, investigations, differential diagnosis and discussed the clinical presentation, investigations and management for chronic liver diseases in pediatric patients.In my slides, I discussed the definition, etiology, natural history of this condition and explained the role of imaging in its diagnosis.
These are my slides after some modifications. I added an aknowlegement page to illustrate Dr Zeinab effort and to thank Dr Khaled Aljasem from Pediatric Department for his effort in revising the original presentations and the constructive feedback he provided which improved the quality of the presented material. Then I added a summary for the parts Dr Zeinab has presented to make this powerpoint presentation complete.
This presentation was presented by Dr Zeinab Salem (from Pediatric Department) and me in a joint tutorial between Pediatric Department and Radiology Department of Sebha Medical Center.
Autoimmune endocrinopathies
Prof. Khaled el Hadidy, UEDA, Beni-Suef University
First Lupus day 16 October 2018 immunology unit, faculty of medicine, Beni-Suef University
The presentation may give you an idea abouth the disease, its pathophysiology, signs, symptoms, diagnosis, treatment....Thanks toall the websites which helped me to make this presentation.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Track: Artificial Intelligence
https://www.etran.rs/2024/en/home-english/
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
1. CELIAC DISEASECELIAC DISEASE
Iman Galal, MDIman Galal, MD
Assistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine
Ain Shams UniversityAin Shams University
E-mail: dr.imangalal@gmail.comE-mail: dr.imangalal@gmail.com
3. Page 3
Historical Aspect:Historical Aspect:
2,000 yrs ago, a Greek physician2,000 yrs ago, a Greek physician
namednamed Aretaeus the CappadocianAretaeus the Cappadocian
provided the 1provided the 1stst
known description ofknown description of
adult patients with celiac disease. Theadult patients with celiac disease. The
namename ‘celiac’‘celiac’ is derived from theis derived from the
Greek forGreek for ‘suffering in the bowels’.‘suffering in the bowels’.
In October 5, 1887,In October 5, 1887, Dr. Samuel GeeDr. Samuel Gee,,
an English Medical Lecturer gave toan English Medical Lecturer gave to
medical students a lecture on themedical students a lecture on the
‘celiac affection’ & this constitutes the‘celiac affection’ & this constitutes the
modern ‘rediscovery’ of celiac disease.modern ‘rediscovery’ of celiac disease.
4. Page 4
Definition:Definition:
Celiac diseaseCeliac disease is an inflammatory autoimmuneis an inflammatory autoimmune
condition of the small intestine, triggered bycondition of the small intestine, triggered by glutengluten inin
genetically susceptiblegenetically susceptible individuals.individuals.
It has diverse multi-systemic clinical manifestationsIt has diverse multi-systemic clinical manifestations
rather than being a 1ry intestinal disease.rather than being a 1ry intestinal disease.
Other terms for celiac disease include:Other terms for celiac disease include: Gluten SensitiveGluten Sensitive
EnteropathyEnteropathy,, Non-Tropical SprueNon-Tropical Sprue && Celiac Sprue.Celiac Sprue.
5. Page 5
Epidemiology:Epidemiology:
Celiac diseaseCeliac disease is more commonly found among whiteis more commonly found among white
Europeans or those of European descent.Europeans or those of European descent.
It is recognized as a common disorder that can be diagnosedIt is recognized as a common disorder that can be diagnosed
at any age but commonly occurs at the age of 1-5 yrs old.at any age but commonly occurs at the age of 1-5 yrs old.
Estimates vary from one in 5,000 to as many as one in everyEstimates vary from one in 5,000 to as many as one in every
300 individuals.300 individuals.
Celiac disease isCeliac disease is 2020 times more common amongtimes more common among type 1type 1
diabetesdiabetes patients than in the general population, that itpatients than in the general population, that it
became recommended to apply screening programs for celiacbecame recommended to apply screening programs for celiac
disease among children recently diagnosed with type 1disease among children recently diagnosed with type 1
diabetes.diabetes.
7. Page 7
Immune Response in Celiac DiseaseImmune Response in Celiac Disease
8. Page 8
Pathological Spectrum of Small IntestinePathological Spectrum of Small Intestine
The classic pathology changes of celiac disease in the small bowel areThe classic pathology changes of celiac disease in the small bowel are
categorized bycategorized by "Marsh Classification""Marsh Classification"::
Marsh stage 0:Marsh stage 0: normal mucosanormal mucosa
Marsh stage 1:Marsh stage 1: ↑↑ intra-epithelial lymphocytes >20/100 enterocytesintra-epithelial lymphocytes >20/100 enterocytes
Marsh stage 2:Marsh stage 2: proliferation of the crypts of Lieberkuhnproliferation of the crypts of Lieberkuhn
Marsh stage 3:Marsh stage 3: partial or complete villous atrophypartial or complete villous atrophy
Marsh stage 4:Marsh stage 4: hypoplasia of the small bowel architecturehypoplasia of the small bowel architecture
10. Page 10
Clinical Presentation:Clinical Presentation:
The most commonly recognized symptoms of celiac disease relate to theThe most commonly recognized symptoms of celiac disease relate to the
improper absorption of food in the GIT.improper absorption of food in the GIT.
Patient presents withPatient presents with diarrhea (<50%)diarrhea (<50%),, steatorrheasteatorrhea,, flatulenceflatulence,,
distended abdomendistended abdomen,, weight lossweight loss, &, & generalized weakness.generalized weakness.
Up toUp to 38 %38 % of patients areof patients are asymptomatic.asymptomatic.
Unrecognized celiac disease may causeUnrecognized celiac disease may cause malabsorptionmalabsorption,, ironiron
deficiency anemiadeficiency anemia,, osteoporosisosteoporosis,, osteomalaciaosteomalacia causingcausing
bone fractures, pain & bony deformities.bone fractures, pain & bony deformities.
People with celiac disease may also experiencePeople with celiac disease may also experience lactoselactose
intoleranceintolerance due todue to lactase enzyme deficiency.lactase enzyme deficiency.
11. Page 11
Dermatitis HypertiformisDermatitis Hypertiformis
Dermatitis herpetiformis (DH)Dermatitis herpetiformis (DH) is the skinis the skin
manifestation of celiac disease.manifestation of celiac disease.
It is anIt is an intensely itchy rashintensely itchy rash that occurs in the hands,that occurs in the hands,
fingers, forearms, buttocks or scalp or anywhere on the body.fingers, forearms, buttocks or scalp or anywhere on the body.
The rash typically consists of intensely itchy, small red dotsThe rash typically consists of intensely itchy, small red dots
that may develop into blisters or pimples.that may develop into blisters or pimples.
ApproximatelyApproximately 10%10% of patients with celiac disease have DH,of patients with celiac disease have DH,
& it is estimated that& it is estimated that > 85%> 85% of patients with DH have celiacof patients with DH have celiac
disease .disease .
13. Page 13
Celiac Disease & the Lung:Celiac Disease & the Lung:
The association betweenThe association between celiac diseaseceliac disease && diffusediffuse
interstitial pulmonary diseaseinterstitial pulmonary disease has been suspectedhas been suspected
sincesince 1970.1970.
Extrinsic allergic alveolitisExtrinsic allergic alveolitis was found in combinationwas found in combination
with celiac disease & it may be considered that both thesewith celiac disease & it may be considered that both these
diseases are based on one common immunologic disorder.diseases are based on one common immunologic disorder.
The association betweenThe association between pulmonary hemosiderosispulmonary hemosiderosis &&
celiac disease have been reported 9 times in literature asceliac disease have been reported 9 times in literature as
an extremely rare combination.an extremely rare combination.
14. Page 14
Other Presentations of Celiac Disease:Other Presentations of Celiac Disease:
NeurologicalNeurological symptoms e.g.,symptoms e.g., peripheral neuropathyperipheral neuropathy,,
ataxiaataxia oror epilepsy.epilepsy.
Apthous ulcersApthous ulcers in the mouth is considered to be anin the mouth is considered to be an
autoimmune disorder associated with celiac disease.autoimmune disorder associated with celiac disease.
Dental enamel defectsDental enamel defects are frequent.are frequent.
Patients with celiac disease may havePatients with celiac disease may have liver diseases.liver diseases.
Abnormal liver testsAbnormal liver tests are common at diagnosis & usuallyare common at diagnosis & usually
improve with treatment.improve with treatment.
16. Page 16
Diagnosis: SerologyDiagnosis: Serology
Serum IgA endomysial antibodies (EMA)Serum IgA endomysial antibodies (EMA) && serumserum
IgA tissue transglutaminase (tTG) antibodiesIgA tissue transglutaminase (tTG) antibodies havehave
bothboth sensitivitysensitivity && specificity > 95%.specificity > 95%.
Testing forTesting for gliadin antibodiesgliadin antibodies is no longeris no longer
recommended because of itsrecommended because of its low sensitivitylow sensitivity &&
specificityspecificity for celiac disease.for celiac disease.
TheThe tTG antibodytTG antibody is theis the recommended singlerecommended single
serologic testserologic test forfor celiac disease screening.celiac disease screening.
17. Page 17
Diagnosis: Small Bowel BiopsyDiagnosis: Small Bowel Biopsy
Required to confirm the diagnosis of celiac disease.Required to confirm the diagnosis of celiac disease.
Should also be considered in patients withShould also be considered in patients with negativenegative
serologicserologic test results who are attest results who are at high riskhigh risk or in whom theor in whom the
physicianphysician strongly suspectsstrongly suspects celiac disease.celiac disease.
Mucosal changes may vary fromMucosal changes may vary from partialpartial toto total villoustotal villous
atrophyatrophy, or may be characterized by, or may be characterized by subtle cryptsubtle crypt
lengtheninglengthening oror increased epithelial lymphocytes.increased epithelial lymphocytes.
To avoid false-negative results on endoscopic biopsy, it isTo avoid false-negative results on endoscopic biopsy, it is
recommend to obtain at leastrecommend to obtain at least 4 tissue samples4 tissue samples to increaseto increase
the sensitivity of the test.the sensitivity of the test.
18. Page 18
Endoscopy & Biopsy in Celiac DiseaseEndoscopy & Biopsy in Celiac Disease
Normal small intestine
Celiac Disease
Normal Villi
Villous Atrophy
22. Page 22
Treatment Options:Treatment Options:
Option #1:Option #1:
Remove the genesRemove the genes
Option #2:Option #2:
Remove the grainsRemove the grains
23. Page 23
Dietary Management in Celiac DiseaseDietary Management in Celiac Disease
At present, the only effective treatment isAt present, the only effective treatment is
aa life-long gluten-free diet (GFD).life-long gluten-free diet (GFD).
No medication exists that will preventNo medication exists that will prevent
damage or prevent the body fromdamage or prevent the body from
attacking the gut when gluten is present.attacking the gut when gluten is present.
Strict adherence to the diet allows theStrict adherence to the diet allows the
intestines to heal, leading to resolutionintestines to heal, leading to resolution
of all symptoms in most cases and,of all symptoms in most cases and,
depending on how soon the diet isdepending on how soon the diet is
begun, can also eliminate the increasedbegun, can also eliminate the increased
risk of complications.risk of complications.
24. Page 24
Dietary Management in Celiac DiseaseDietary Management in Celiac Disease
25. Page 25
Follow-Up:Follow-Up:
Serologic markersSerologic markers (serum IgA tTG)(serum IgA tTG) used to monitorused to monitor
compliancecompliance with GFD.with GFD.
Antibody levelsAntibody levels return toreturn to normalnormal withinwithin 3-12 months3-12 months ofof
starting a GFD but may take up tostarting a GFD but may take up to 30 months30 months if the initialif the initial
titers are high.titers are high.
Repetition of small bowel biopsyRepetition of small bowel biopsy 3-4 months3-4 months afterafter
initiation of a GFD isinitiation of a GFD is not necessarynot necessary if the patient respondsif the patient responds
appropriately to therapy.appropriately to therapy.
If the patient does not respond as expected revise the→If the patient does not respond as expected revise the→
patient’s adherence to GFD, then the physician shouldpatient’s adherence to GFD, then the physician should
consider other differential diagnosis.consider other differential diagnosis.
26. Page 26
Prognosis:Prognosis:
Treating CD with a strictTreating CD with a strict GFDGFD is alwaysis always completely effective.completely effective.
Gastrointestinal complaints & other symptoms resolve in almost allGastrointestinal complaints & other symptoms resolve in almost all
patients.patients.
Once the diet has been followed for several years, individuals with CD haveOnce the diet has been followed for several years, individuals with CD have
similar mortality ratessimilar mortality rates as the general population. However, aboutas the general population. However, about 1010
%% of patients with celiac disease developof patients with celiac disease develop lymphomalymphoma && small bowelsmall bowel
adenocarcinoma.adenocarcinoma.
A few patients develop aA few patients develop a refractory typerefractory type of CD, in which the GFD noof CD, in which the GFD no
longer seems effective.longer seems effective.
Experts emphasize the need forExperts emphasize the need for lifelong adherence to the GFDlifelong adherence to the GFD toto
avoid the long-term complications of this disorder. They point out thatavoid the long-term complications of this disorder. They point out that
although the disease may have symptom-free periods if the diet is notalthough the disease may have symptom-free periods if the diet is not
followed, silent damage continues to occur.followed, silent damage continues to occur.
According to medical authorities, CDAccording to medical authorities, CD cannot be outgrowncannot be outgrown oror cured.cured.
27. Page 27
American Gastroenterological Association InstituteAmerican Gastroenterological Association Institute
Recommendations for Celiac Disease ScreeningRecommendations for Celiac Disease Screening
Consider testing in symptomatic patients at high riskConsider testing in symptomatic patients at high risk
for Celiac Disease with any of the following conditions:for Celiac Disease with any of the following conditions:
Autoimmune hepatitisAutoimmune hepatitis
Down syndromeDown syndrome
Premature onset of osteoporosisPremature onset of osteoporosis
Primary biliary cirrhosisPrimary biliary cirrhosis
Unexplained elevations in liver transaminase levelsUnexplained elevations in liver transaminase levels
Unexplained iron deficiency anemiaUnexplained iron deficiency anemia
Type 1 DMType 1 DM
28. Page 28
References:References:
Presutti J,Cangemi J, Cassidy H, Hill D, Celiac Disease.Presutti J,Cangemi J, Cassidy H, Hill D, Celiac Disease.
American Family Physician. December 15, 2007: 1795-American Family Physician. December 15, 2007: 1795-
1802.1802.
Hadithi M, von Blomberg BM, Crusius JB, et al. (2007).Hadithi M, von Blomberg BM, Crusius JB, et al. (2007).
"Accuracy of serologic tests and HLA-DQ typing for"Accuracy of serologic tests and HLA-DQ typing for
diagnosing celiac disease". Ann. Intern. Med. 147: 294–diagnosing celiac disease". Ann. Intern. Med. 147: 294–
302.302.
Hood J, Mason AMS. Diffuse pulmonary disease withHood J, Mason AMS. Diffuse pulmonary disease with
transfer defect occurring in coeliac disease. Lancettransfer defect occurring in coeliac disease. Lancet
1970;1:445-47.1970;1:445-47.
After absorption in the small intestine these proteins interact with the antigen-presenting cells in the lamina propria causing an inflammatory reaction that targets the mucosa of the small intestine.
Gluten is the term for the storage proteins of wheat. The alcohol-soluble fraction, called gliadin
A histologic section of normal jejunum is seen in the upper left panel. With the dissecting microscope these villi have the appearance of that seen in the lower left panel. A histologic section and a dissecting microscopic view of gluten enteropathy are shown in the upper right and lower right panels respectively.
Endoscopic and biopsy findings in patients with and without celiac disease. (A) High-definition endoscopic photo of normal small intestine. The villi are clearly visible with no evidence of atrophy or scalloping of the folds. (B) Biopsy specimen of normal small intestine (hematoxylin-eosin; original magnification, × 100). (C) PillCam image of small intestine in a patient with celiac disease, showing scalloping of the mucosal folds (arrows) characteristic of a malabsorption pattern. There is also evidence of villous atrophy compared with normal. (D) Biopsy specimen of small intestine in a patient with celiac disease (hematoxylin-eosin; original magnification, × 100). Note the loss of villous architecture.
