Celiac disease is caused by an autoimmune response by the immune system. Meaning that the immune system wrongfully attacks a healty tissue when another component is targeted. This occurs when it detects the gluten protein in the body. By responding with an attack on the protein it unintentionally damages the small intestine as well. The body detects gluten as a threat even though it is non-harmful substance.
Symptoms and negative health consequences of celiac disease include: diarrhoea, bloating, abdominal pain, weight loss, fatigue (as a result of malnutrition), lactose intolerance, central and peripheral nervous system disorders, gall bladder malfunctions, etc. Nutritional deficiencies of iron, minerals and vitamins are also related symptoms.
As mentioned the body’s immune response to “attack” the gluten unintentionally damages the small intestine. It specifically damages the villi of the small intestine, small projections which increase the surface area for nutrient absorption. This is known as villous atrophy.
Since the surface area of absorption is decreased the body can no longer absorb nutrients as efficiently. This explains the reasons of the symptoms related to the disease. There is a lack of absorption of nutrients such as vitamin A, D, E and K- all of which are essential to our metabolism. Therefore the body is malnourished, leading to fatigue due to the lack of energy from the unabsorbed foodstuffs. Due to the lack of being able to digest gluten patients experience bloating and diarrhea. Lactose intolerance arises through the lowered productivity level of lactase production as well as the reduced absorption surface. Gall bladder malfunction and other symptoms also arise due to the reduced production of enzymes and hormones, which are usually produced in healthy small intestines. In the case of gall bladder malfunction it is due to the lack of the hormone responsible for gall bladder contraction, CCK (cholecystokinin), which is produced in the duodenum.
Celiac disease is genetic and therefore inheritable. In the UK it affects 1 in 100 people. It is caused by the genetic mutation of specific genes known as HLA-DQ genes. These genes are responsible for the development of the immune system which distinguish cells between self and non-self. These genes are located on the sixths chromosome. Depending on which variations of alleles an individual inherits, the risk of developing celiac disease will increase.
Celiac disease can be diagnosed by a blood test in which the levels of the antibodies that act against gluten are tested for. People with a higher level of these specific antibodies will have celiac disease. An upper endoscopy may as well be carried out as a diagnostic method. In the procedure multiple biopsies are taken from along the duodenum and jejunum to be examined- since at simple eyesight a damage cannot always be established.
Pathological changes categorized by the Marsh Classification can indicate the presence of celiac disease.
Marsh Stage 0: Normal mucosa.
Marsh Stage 1:Increased number of intraepithelial lymphocytes.
Marsh Stage 2: Proliferation of the crypts of Lieberkhün.
Marsh Stage 3: Partial or complete villous atrophy.
Marsh Stage 4: Hypoplasia of small intestine.