Friday, 13 May 2011

Celiac Disease

Silent and deadly, celiac disease is an autoimmune digestive disorder, affecting nearly three million people in America. The disorder is triggered in genetically susceptible people of all ages by the consumption of gluten protein found in wheat, barley and rye. This results in the destruction of the villi of small intestine, by the immune reaction leading not only to the malabsorption of nutrients but also causing a damage to the intestinal walls.

The history of celiac disease is a thought provoking tale. It has been in existence since the prehistoric ages, when the nomadic man stopped gathering fruits and nuts to settle down. This eventually lead to civilization and growth of agriculture. With this spurt in agriculture and domestication of animals, the Neolithic man was introduced to a new diet which differed starkly from his previous diet. While some people were able to adapt to this new food diet, comprising cereals and animal protein, others developed food intolerances. This led to the birth of celiac disease also known as the coeliac disease, celiac sprue, endemic sprue, gluten enteropathy and gluten intolerence.

The earliest known record of this disease was when the Greek physician, Aretaeus of Cappadocia, wrote about 'the coeliac affection' in the second century A.D. He described the condition as, "If the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs". He termed the Greek word 'koiliakos' to describe the people afflicted with the disorder. The book contains references of fatty diarrhea and also provides the symptoms of the disease in adults and children. Translated in 1856 by Francis Adams, the original Greek text is believed to have been a remarkable insight into the disease.

Around seventeen centuries later, the next clinical account of the disease by Mr. Mathew Baillie followed. He recorded his observations on chronic diarrheal disorder and even suggested dietary remedies for it. However it was the work of an English doctor, Mr. Samuel Gee who provided the modern description of the disease and documented the importance of the gluten free diet. Subsequent contributions were made by Herter, a pediatrician who observed that fats are tolerated better than carbohydrates. This theory was supported by Sir Frederick Sill and further developed by Howland. He propounded the three stage diet where carbohydrates were introduced in the last stage.

In 1924, a dietetic therapy was introduced by Sidney Haas known as the 'banana diet'. It was based on the successful treatment of eight anorexic children, with the banana diet. He concluded that the culprit of the disease was carbohydrates. Although this theory held ground for nearly two decades, the myth was shattered through a fundamental discovery made by professor Dicke. He documented that it was wheat protein and not starch which caused celiac disease. The next breakthrough came with the discovery of the introduction of jejunal biopsy apparatus by Margaret Shiner. Thus at the turn of the century it had been established that the disorder was the result of gluten, that the mucosal lesion became easily identifiable and intestinal biopsy became the standard diagnosis.

An encouraging insight gained by the continual research in the symptoms and treatment of celiac disease is that, with a strict gluten free diet the flat lining of the coeliac small intestine could be recovered. The results were highly positive for the younger patients who were tested on.

Referred to as the most under diagnosed disease in the United States, only three percent of the afflicted people are actually diagnosed with the disease. Since the symptoms of the disease are similar to other diseases, it is difficult to identify. However with doctors becoming aware of the symptoms of celiac disease and with reliable blood tests, diagnosis rates have shown an upturn.

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