Gluten is a protein commonly found in many foods, such as bread, pasta, cakes, as well as any foods containing wheat, flour, and barely. For many, gluten is in some of their most consumed foods. However, there are some who live with a disease known as celiac disease, which is a systemic immune disorder triggered by an intake of gluten, which can severely damage the small intestine (Fasano 2012). This disease is seen as an extensive health-care problem, as developments in screening and diagnostic methods have discovered its pervasiveness worldwide. Celiac disease has been characterized by an autoimmune response in affected individuals which results in a small-intestinal mucosal injury, or injury to the membrane lining of the small intestine. Consequently, resulting in a development of malabsorption, eventually leading to malnutrition in the body. Thus, culminating a pleathora of maltutrition-related issues such as vitamin deficiencies, animia, neurological disorders, and osteoperosis (Tack, Greetje J., et al. 2010).
There are numerous environmental risk factors and a genetic risk factor that can contribute to the evolution of celiac disease such as gluten integration at childhood, infectious agents and socioeconomic features, or the existence of two human leukocyte antigens (HLA) (Tack, Greetje J., et al,). The environmental risk factors include gluten introduction in childhood, infectious agents, and socioeconomic features. It is widely debated how infant feeding may lead to celiac disease, however there is evidence that leads scientists to assume that introducing gluten to infants abruptly after they finish breastfeeding or formula can increase the onset of the disease. Another factor in infant feeding that possibly contributes to the development of this disease are increased gluten content in commercial baby foods (Tack, Greetje J., et al,). In regards to infectious agents, it has been proposed that celiac disease can develop in infections after birth. It was discovered that frequent rotavirus infection can represent a specific independent risk factor for celiac disease. As rotavirus infections can cause changes in the permeability and balance of cytokine in the intestinal mucosa, which stems the possibility of enhancing the penetration of gluten peptides (Tack, Greetje J., et al,). The final environmental risk factor is socioeconomical features, a study found that the lower the socioeconomic background an individual comes from can actually prevent against the development of celiac disease. A genetic risk factor of celiac disease includes the presence of one of two HLA genes. This disease is considered a multigenetic disorder, meaning the most dominant risk factors are encoded genotype HLA class II molecules HLA-DQ2 and HLA-DQ8. Around 90% of those who have celiac disease carry the DQ2 encoded variation, while most of the rest carry the DQ8 encoded variation (Tack, Greetje J., et al,).
After covering some risk factors of celiac disease, some of the symptoms associated with this disease can include typical gastrointestinal symptoms (e.g., diarrhea, bloating, abdominal pain), and/or non-gastrointestinal abnormalities (e.g., iron deficiency/anemia, skin disorders, bone disease). And on the opposite side of the spectrum some show no symptoms at all (Rubio-Tapia, Alberto and others 2013). When taking each symptom into consideration and bringing up the possibility one may have celiac disease to their doctor, there are different symptoms that are strongly associated with having celiac disease. Some of the most strongly associated ones are if someone in the patient’s immediate family (parents, offspring, sibling, etc.) has a confirmed diagnosis of the disease, patients with symptoms and/or laboratory evidence related to malabsorption (high sign of small intestine damage) such as diarrhea, abdominal pain, bloating, etc., and patients with Type 1 Diabetes (Rubio-Tapia, Alberto and others 2013). After consulting with a doctor there must be a laboratory diagnosis, some of the ways in doing so include an immunoglobulin A anti-tissue (IgA) transglutaminase (TTG) antibody test (in which an IgA deficiency is highly correlated with celiac disease), or a blood diagnostic test while the patient is on a gluten-containing diet (Rubio-Tapia, Alberto and others 2013). After the laboratory diagnosis the doctor must then confirm the testing through other methods of diagnosis, which all vary. Some of these conformational tests include a finding based on a combination of previous medical history, a physical examination, and a biopsy of the duodenum (the first part of the small intestine). Others include a biopsy of the small-bowl with an upper endoscopy, which visualizes the upper gastrointestinal tract without using an incision, and a lymphocytic infiltration of the intestinal epithelium (Rubio-Tapia and others 2013).
After receiving the diagnosis of celiac disease there are many roads of treatment patients can take. One of the most common is adopting an entirely gluten-free diet. With the adoption of a gluten free diet, patients should void any foods containing wheat, rye, or barley proteins. Gluten can be exchanged with other dietary proteins. However, the consumption of some nutrients (i.e. fiber, iron, calcium, and folate) tend to be lower than normal in patients who adopt a gluten-free diet (Fasano 2012). In continuation, even though a completely gluten-free diet is optimal, there is some research that suggests that 50-110 mg of gluten per day is the threshold in which the lowest amount of daily gluten can actually cause damage to the intestine (Fasano 2012). With a maintained gluten-free diet the celiac antibodies that course this disease should gradually disappear within 6-24 months after adopting the diet. Nonetheless, even when a gluten-free diet is seemingly the best option, in a large number of patients who are symptom free and have a reversion of some symptoms, minimal intestinal damage still persists. In addition, an indefinite gluten elimination can create psychological and/or social implications. Adults and adolescents with celiac disease detail concerns with relationships and management of their daily lives. One of the most important aspects of maintaining a gluten free diet include support from friends and family as well as knowledgeable education in regards to their disease (Fasano 2012). Another treatment that is fairly new and is still being tested out include the engineering of gluten-free wheat. Researchers have created a way of genetically engineering wheat that contains much of the most troublesome type of gluten, while, also keeping the other proteins that give bread its characteristically taste and springiness (Saplakoglu 2017). However, in doing so the biggest concern coming from this genetical modification comes up during the method of injecting DNA from one species to another. In this study these scientists used a specific gene-editing technique to cut out selected genes from portions of the wheat genome. Their study targeted alpha-gliadins, or gluten proteins suspected to be the main agitator in wheat in turn causing immune system damage in those with celiac disease. Once the altered wheat was tested in the petri dish, it bred an up to 85% weaker immune response (Saplakoglu 2017).
In conclusion, there are many factors that contribute to the development of celiac disease, which can stem from one’s environment or one’s genetic makeup. As well as many varying symptoms that one could experience ranging from typical gastrointestinal symptoms, to non-gastrointestinal abnormalities, to even no symptoms at all. A completely gluten-free diet is considered the most optimal treatment in this disease, however, many gluten-free foods lack some of the identifying characteristics that foods with gluten have, such as elasticity. As modern medicine continues to develop there are ways of modifying natural foods, such as wheat, in order to create gluten-free foods that have characteristics of gluten-containing foods.
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