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Celiac Disease in womenCeliac Disease in women
Lugansk State Medical UniversityLugansk State Medical UniversityBlock 50 years, Of lugansk defence, 1.Block 50 years, Of lugansk defence, 1.
Lugansk - 91045, Ukraine.Lugansk - 91045, Ukraine.
email : [email protected] / [email protected] : [email protected] / [email protected]
Official website - http://www.lsmuedu.comOfficial website - http://www.lsmuedu.com
+38-091-9484-428+38-091-9484-428
Learning ObjectivesLearning 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
Magnitude of the Problem of Celiac DiseaseMagnitude 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, thyroid
disorders 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.
DefinitionDefinition
• 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 the
normal absorption of food leading to nutritional deficiencies
and therefore, can affect the body in many different ways.
IncidenceIncidence
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 be
explained 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.
IncidenceIncidence (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.
Effect on MenstruationEffect on Menstruation
1- Amenorrhea is a possibility
2-Short fertile period: affected women have late menarche and
early menopause
Effect on pregnancy and lactationEffect 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
Effect on pregnancy and lactationEffect 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
Effect on FertilityEffect on Fertility
1- Unexplained infertility
2-Recurrent miscarriages
3-Poor quality seminal fluid was detected in males affected with
celiac disease
Effect on bone mineral densityEffect 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 bone
turnover.
• Treatment with vitamin D may be required in the presence of
osteomalacia.
ComplicationsComplications
1-Malignancies: lymphoma of the small intestine, non Hodgkin’s
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 not
responding to, free gluten diet
DiagnosisDiagnosis
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
Diagnosis Diagnosis (Cont.)(Cont.)
II-Serology: tests are used to measure antibodies formed against
the 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)
Diagnosis Diagnosis (Cont.)(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 a
biopsy if the clinical suspicion is high. 4-8 biopsies should be
obtained for diagnosis from either the distal duodenum or the
proximal jejunum.
Diagnosis Diagnosis (Cont.)(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.
TreatmentTreatment
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
Treatment Treatment (Cont.)(Cont.)
2-Avoid medications and vitamin preparations which contain
gluten.
3-Steroids or immunosuppressants in refractory cases
4- Supplemental iron, folate, B12, calcium and magnesium.
LUGANSK STATE MEDICAL LUGANSK STATE MEDICAL UNIVERSITYUNIVERSITY
Lugansk State Medical UniversityBlock 50 years, Of lugansk defence, 1.
Lugansk - 91045, Ukraine.email : [email protected] / [email protected]
Official website - http://www.lsmuedu.com+38-091-9484-428
