CELIAC DISEASE
Pathophysiology
Adults

Symptoms
Small intestine: inflammation and immune response cause villi to atrophy and
flatten, if damage to intestinal mucosa continues, it will result in decreased
surface area for absorption, reduced number of nutrient transport carriers (within
mucosal cells), mucosal deficiency of disacharidases & peptidases, and damage
to intestinal crypt (enzyme secreting) cells, resulting in impaired secretory,
digestive, and absorptive function
GIT: Indigestion, bloating, nausea, diarrhea, chronic constipation, flatulence,
abdominal cramps, malabsorption, and steatorrhea
Other: Anemia, osteoporosis, osteopenia, osteomalacia, muscle weakness,
weight loss, apathy/fatigue/malaise, Malodorous stools, ataxia, polyneuropathy,
infertility (and other endocrine disorders), follicular hyperkeratosis, dermatitis
herpetiformis (itchy rash), arthritis and vitamin/mineral deficiencies (Vit A, D,
E, K, calcium, iron, folate)
Delayed puberty
Adolescents

Etiology
 Idiopathic
Consists of 4 main components:
Delayed growth, poor somatic muscle mass, hypotonia, abdominal distension,
peripheral edema, depleted subcutaneous fat stores, delayed
Infants/children  bone growth and development
Risk Factors
& Triggers

Initial Screening
Diagnosis
Goals for
MNT
 Genetic predisposition
 Environmental trigger
 GI stress, GI surgery, pregnancy, severe emotional stress, impaired
immune system, viral infection
 Exposure to various prolamin peptide fractions ex. gliadin
 Autoimmune response to prolamins
 Clinical evaluation
 Presence of herpetiformis dermatitis in combination with s/sx listed
above
 FHx
 Blood serum tests, see “Labs” below
 Biopsy of small intestine, showing:
 Villous atrophy
 Increased intraepithelial lymphocytes
 Crypt cell hyperplasia
 Clinical evaluation (see “Initial Screening” above)
 Lab tests, (see “Labs” below
 Gluten-free (GF) diet education
 Develop and manage a GF diet
 Reduce GIT inflammation
 Reduce or eliminate symptoms
 Regain or establish normal GI functioning with normal nutrient absorption.
Labs



Nutrient Needs
Treat nutritional deficits and ensure adequate intake or supplementation
Blood serum evaluating the presence of specific antibodies:
 Anti-tissue transglutaminase (anti-TTG)
 Anti endomysial antibodies
 Deaminated gliadin peptide
Decreased IgA levels
Kcal: Maintenance 25-27 kcal/kg
Pro:
0.8-1.0 g/kg
CHO: Minimize foods that are refined, or contain “simple” refined sugars.
Eliminate foods containing allergens, per individual needs.
DRI >130 g/d
Fiber: Increase fiber if diet low in fiber with emphasis on soluble fibers.
DRI: Females 21-25 g/d
Males 30-38 g/d
Fluids: 35-40 ml/kg; ensure adequate fluids to support fiber recommendations

To reduce GI inflammation – Omega-3 Fatty Acids, Quercetin, Ginger, Aloe,
Medications
Marshmallow Root, Slippery Elm
 To stimulate restoration of gut mucosa – Glutamine, Arginine
 To reverse or prevent further loss of BMD - Calcium and Vitamin D
 To eliminate Anemia – Folate/Iron/ B12 (where appropriate)
Supplements/Herbs/  To restore healthy microflora - Probiotics – B. bifidum or L. acidophilus
Botanicals
 To inhibit growth of yeast, fungus – oregano and peppermint oils/teas
Most of these herbs may
 To reduce GI inflammation – omega-3 fatty acids, quercetin, ginger, aloe,
cause GI distress in larger
marshmallow root, slippery elm
doses or if used long To stimulate restoration of gut mucosa – glutamine, arginine
term.
 To restore normal digestion – oral betaine HCl, pancreatic enzymes, fiber
 Elimination of all prolamins (gluten-forming peptides in wheat, rye, barley,
Medical
and possibly oats ) from the diet
Nutrition
 Assessment of common Celiac Disease related nutrient deficiencies:
Therapy
 Folate content in red blood cells
 Ferritin (Iron utilization)
 25-Hydroxy vitamin D
 If severity of pt Sx are high, further assessment of nutrient deficiencies is
necessary: Vitamins A, E, & K and Zinc
 Educate pt on food sources that will be needed to replace the nutrient content
of gluten-containing foods
 Iron
 Folate (if normally consumed in the form of folic acid)
 B vitamins (Thiamin, Niacin, Riboflavin)
 Educate individual and partner/family on:
 Label readings
 Safe food additives
 Food preparation
 Possible sources of cross contamination
 Monitor for relief of GI, skin, neurological and autoimmunity sxs.
 Ensure that the pt has all of
Other
Considerations