Celiac disease: a multi organ autoimmune disease presentation and nutritional management

Celiac disease [CD] is defined as a T-lymphocyte mediated small intestinal enteropathy induced by gluten in individuals with a genetic predisposition. Population based serological studies reveal that CD is not rare and can also present in adulthood. Classic symptoms of CD are gastrointestinal however non-gastrointestinal symptoms may be related to the skin, bone, heart, nervous system, reproductive system, growth retardation, as well as various manifestations of nutrient deficiency such as anemia. However it can also be silent or latent for many years. Primary care physicians and nutritionists in developing countries are not aware of the multi organ nature of this disease and therefore CD is under diagnosed. Exclusive breast feeding for 6 months and appropriate weaning practices can prevent/delay the occurrence of CD. Serological testing can identify patient with CD but intestinal biopsy is the gold standard for diagnosis. At diagnosis, anthropometric assessment and biochemical/clinical assessment of iron, zinc, B12, folic acid and fat soluble vitamins status should be done. Treatment consists of following a gluten free diet for life i.e. exclusion of all wheat, barley and rye and correction of underlying nutritional deficiencies. In developing countries primary care physicians must play a major role in diagnosing and managing CD due to the inaccessibility/unavailability of trained specialists and nutritionists. There is a dire need for trained nutritionists to provide counseling and support to patients with CD in developing countries