Gluten CELIAC DISEASE PowerPoint Presentation on CD

 All derivative (i.e. change in media; by compilation) work from this underlying U.S. Government public domain/public release data is COPYRIGHT © GOVPUBS

$3.00 first class shipping in U.S. and rest of world.

Includes the Adobe Acrobat Reader for reading and printing publications.

Numerous illustrations and matrices.

Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats:

TITLE:

 Celiac Disease - A not so  Uncommon Disorder, 31 pages (slides) 

SLIDE TOPICS, SUBTOPICS and CONTENTS:

Celiac Disease-A not so  Uncommon Disorder
Frank A. Hamilton, M.D., MPH
National Institutes of Health
National Institute of Diabetes, Digestive and Kidney Diseases
August 19, 2005
Definition
Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. 

It occurs in symptomatic subjects with gastrointestinal and non-gastrointestinal symptoms, and in some asymptomatic individuals, including subjects affected by:
   
   
Clinical Manifestations
Gastrointestinal (“classical”)
Non-gastrointestinal ( “atypical”)
Asymptomatic
The Celiac Iceberg
Gastrointestinal Manifestations (“Classic”)
Typical Celiac Disease
Non Gastrointestinal Manifestations
Dermatitis herpetiformis
3 – Asymptomatic
Silent: No or minimal symptoms, “damaged” mucosa and
    positive serology
        Identified by screening asymptomatic individuals  
            from groups at risk such:

First degree relatives
Down syndrome patients
Type 1 diabetes patients, etc.

Associated Conditions
Relatives
Healthy population:     1:133
1st degree relatives:     1:18 to 1:22
2nd degree relatives:     1:24 to 1:39
Major Complications of Celiac Disease
Short stature
Dermatitis herpetiformis
Dental enamel hypoplasia
Recurrent stomatitis
Fertility problems


Osteoporosis
Gluten ataxia and other neurological disturbances
Refractory celiac disease and related disorders
Intestinal lymphoma

Epidemiology
The “old” Celiac Disease Epidemiology:
   
“Mines” of Celiac Disease Were Found Among:
Celiac Disease Epidemiological Study in USA
Celiac Disease Prevalence Data
Celiac Disease Icebergs
The Global Village of Celiac Disease
Diagnosis
Serological Tests
Serological Tests
Treatment
Only treatment for celiac disease is a gluten-free diet (GFD)
Strict, lifelong diet
Avoid:
Wheat
Rye
Barley 
Oats –are they Safe?
Studies from 1970’s suggested that oats were toxic in CD
Oats contain a protein-avenin
Avenin- similar to wheat gliadin
Both are prolamins –rich in glutamine and proline, both amino acids
OATS
Avenin- proportion of proline and glutmaine is very low in oats compared to gliadin in wheat
2004, Random. Clin Trial  in
children fed GFD vs. GFD with oats
Hogberg Gut May 1,  2004 53(5)649-654.
Findings
First large study to indicate that oats in GFD  do not prevent normalization of the small bowel tissue or celiac markers.
Other evidence supporting the safety of oats; G. Kilmartin Gut, January 1, 2003
In CD, oats are not toxic and immunogenic, Srinivasan BMJ 1996:1300-01
Sources of Gluten
Treatment – 6 Elements in RX
Consultation with a skilled dietitian Education about the disease
Lifelong adherence to a gluten-free diet
Identification and treatment of nutritional deficiencies
Access to an advocacy group
Continuous long-term follow-up by a multidisciplinary team


Barriers to Compliance
Ability to manage emotions – depression, anxiety
Ability to resist temptation – exercising restraint
Feelings of deprivation
Fear generated by
    inaccurate information

Factors that Improve Adherence
Internal Adherence Factors Include:
Knowledge about the gluten-free diet
Understanding the risk factors and serious complications can occur to the patient
Ability to break down big changes into smaller steps
Ability to simplify or make behavior routine
Ability to reinforce positive changes internally
Positive  coping skills
Ability to recognize and manage mental health issues
Trust in physicians and dietitians
Histological Features