Immunological diseases and Conditions // Drug Repurposing

Immunological diseases and Conditions

Conditions related to CD.

This chart, extracted from the NEJM journal lists a surprisingly large number of linked conditions for those people as yet unaware of the many interrelated problems. However it does not list thyroid autoimmunity issues in the list, possibly as this is now 9 years old. Clinically once a patient has been identified as having CD of Thyroid antibodies there should be a cross-diagnostic work up. Even gluten sensitivity may account for increased autoantibodies to the thyroid and reduced thyroid functionality, the symptoms of which may fully respond to a gluten free diet.

Diagnosis

The mechanisms for clinical diagnosis have classically relied on the evidence of epithelial brush border loss as the defining sign, but these days as gluten sensitivity takes on an increasing importance in the clinical presentations of patients with reactivity to gluten there are increasingly sensitive investigations.

Children.

Classically, infants with celiac disease present between the ages of 4 and 24 months with impaired growth, diarrhoea, and abdominal distension. Vomiting is common in young infants, as are pallor and oedema. The onset of symptoms is gradual and follows the introduction of cereals into the diet. The velocity of weight gain slowly decreases before weight loss ensues. Some children present with constipation, although diarrhoea is more typical.

Patients with severe, untreated celiac disease may present with short stature, pubertal delay, iron and folate deficiency with anaemia, and rickets. Atypical celiac sprue is usually seen in older children or adolescents, who often have no overt features of malabsorption. In addition to recurrent abdominal pain, hypertransaminasemia, recurrent aphthous stomatitis, arthralgia, and defects in dental enamel, children may have behavioural disturbances such as depression, may be irritable, and may perform poorly in school.

Adults

The diagnosis of adults with coeliac disease is increasing. Some 20% of people diagnosed are over 60, and for every person diagnosed an estimated 8 others are missed or do not seek a suitable diagnostic work up. Many have been symptom free for most of their life suggesting that gluten sensitivity and coeliac disease can develop during adulthood. The prevalence of coeliac disease in the general population is believed to be close to 1 in 300.

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