Celiac Disease Kandeel

8/2/2019 Celiac Disease Kandeel

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Celiac Disease in women

Mohamed Kandeel, M.D.

Professor of Obstetrics and Gynecology

Menofyia University

Egypt


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Learning Objectives

At the end of this presentation you should:

1-Enumerate the problems a woman affected with celiac disease

may encounter during her life

2-Be aware of the methods of diagnosis of celiac disease

3-Describe effective control for the disease to minimize

symptoms and long term sequelae of the disease


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Magnitude of the Problem of Celiac Disease

Celiac disease is an autoimmune disease affecting the small

intestine. Various studies have shown its association with

other autoimmune endocrinologic disorders affecting different

organs -systems- of the body such as diabetes, thyroiddisorders and infertility. In fact 50% of patients affected with

celiac disease have atypical presentations not involving the

GIT and consequently, many celiacs are expected to seeks

medical advice from specialists other than gastroenterologists.

We, as Ob/Gyns, should be aware of the different

presentations of the disease that we may encounter at the

office.


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Definition

Celiac disease is a life long autoimmune enteropathy affecting

small intestine characterized by a permanent intolerance to

dietary gluten. Gluten is a protein found in the cereal grains of

wheat, rye, barley & oats.

In affected individuals, ingested gluten causes inflammation

and damage to the small bowel. This damage impairs thenormal absorption of food leading to nutritional deficiencies

and therefore, can affect the body in many different ways.


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Incidence

The incidence of Celiac disease varies between 1-100 to 1-300

in the general population according to geographical

distribution. Generally speaking, celiac disease is more

common in women than men. This high incidence can beexplained by the fact that women are more keen about their

health compared to males and therefore, they seek early

medical advise. The high incidence of the disease in women

can be just a simple reflection of this behavior.


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Incidence (Cont.)

The incidence of celiac disease varies among specific groups.

It ranges between 4-8% among women diagnosed with

unexplained infertility. About 6% of anemic women have

undiagnosed celiac disease. A recent study suggested that 3-4% of women who have osteoporosis have celiac disease.


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Effect on Menstruation

1- Amenorrhea is a possibility

2-Short fertile period: affected women have late menarche and

early menopause


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Effect on pregnancy and lactation

1-Iron deficiency anemia: due to

a-Malabsorption of dietary iron

b-Occult blood loss from gastro-intestinal tract

2-Poor absorption of folic acid leading to recurrent miscarriages

and increased theoretical risk of of neural tube defects in

babies of affected mother


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Effect on pregnancy and lactation

3-Increased incidence of IUGR and low birth weight babies

4-Higher incidence of preterm birth and Cesarean sections among

affected mothers

5-Shorter duration of breast feeding


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Effect on Fertility

1- Unexplained infertility

2-Recurrent miscarriages

3-Poor quality seminal fluid was detected in males affected with

celiac disease


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Effect on bone mineral density

Celiac disease decreases bone mineral density in affected

women. The underlying mechanism is related to calcium

malabsorption and subsequent increase in parathormone

secretion by the parathyroid which, in turn, increases boneturnover.

Treatment with vitamin D may be required in the presence of

osteomalacia.


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Complications

1-Malignancies: lymphoma of the small intestine, non Hodgkins

lymphoma, Cancer of the pharynx, oesophagus and small

intestine are all well recognized in association with celiac

disease.

2-Osteoporosis

3- Bleeding tendency

4-Refractory celiac disease: in longstanding cases not on; or notresponding to, free gluten diet


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Diagnosis

I- Symptoms include:

50% of patients show the classic form of the disease of chronic

diarrhoea, nausea, vomiting, flatulence, bloating, abdominal

pain and weight loss. Fatigue, weakness and lethargy are also

common associated symptoms.

Many affected adults lack GI symptoms & present with a wide

spectrum of manifestations such as insulin-dependent diabetes,

joint pains, osteoporosis, iron, folate, B12 deficiency,

depression, dermatitis herpetiformis & infertility


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Diagnosis (Cont.)

II-Serology: tests are used to measure antibodies formed againstthe breakdown products of ingested glutens and the enzymes

that mediate the tissue damage in the disease. Because of their

high sensitivity, they are used for screening. They also can be

used to monitor response of patients on strict gluen diet.

1-Antigliadin antibodies (AGA)

2-Anti-tissue antibodies (tTGA)

3-Antiendomysial antibodies (EMA)


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Diagnosis (Cont.)

III-The gold standard diagnostic test is endoscopic biopsy of the

upper small bowel. Because of the invasive nature of this, it

should be reserved only for those with positive screening

serology tests. However, A negative test may still prompt abiopsy if the clinical suspicion is high. 4-8 biopsies should be

obtained for diagnosis from either the distal duodenum or the

proximal jejunum.


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Diagnosis (Cont.)

IV-Prothrombin time and partial thromboplastin time: useful to

identify deficiency of vitamin K, which predisposes patients to

hemorrhage

V-Radiology: has no role in the diagnosis of celiac disease.

However, it can help rule out other pathologies of gastro-

intestinal disease.


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Treatment

1-The standard treatment is gluten free diet for life. It is essential

to relieve symptoms and avoid long term complications of the

disease. Avoid all foods made from wheat, rye, and barley.

Examples are:

-Breads, cereals, pasta, cakes and cookies

-Sausages, processed and canned meats-Yogurt, ketchup and mustard

-Candy bars and ice cream


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Documents

Celiac Disease Kandeel