Celiac Disease
Description
- Also called Gluten-Sensitive Enteropathy.
- Is a disease of the small intestine marked by atrophy of the villi and microvilli caused by an immune-mediated inflammatory response to gluten, a protein found in common grains such as wheat, rye, oats, and barley.
- The cause is unknown, but genetic, environmental, and immunologic elements maybe involved.
- The disease is triggered by surgery, pregnancy, viral infection, or severe emotional distress.
- It is most common in young children ages 6 to 24 months but can occur at any age.
- Symptoms typically diminish or disappear in adolescence and reappear in early adulthood.
- Complications include impaired growth, inability to fight infections, electrolyte imbalance, clotting disturbance, and possible predisposition to malignant lymphoma of the small intestine.
Assessment
Ages 3 to 9 months
- Acutely ill; severe diarrhea and vomiting
- Irritability
- Possible failure to thrive
Ages 9 to 18 months
- Slackening of weight followed by weight loss
- Abnormal stools
- Pale, soft, bulky
- Offensive odor
- Greasy (steatorrhea)
- May increase in number
- Abdominal distention
- Anorexia, discoloration of teeth
- Muscle wasting: most obvious in buttocks and proximal parts of extremities
- Hypotonia, seizures
- Mood changes: ill humor, irritability, temper tantrums, shyness
- Mild clubbing of fingers
- Vomiting: usually occurs in the evening
- Aphthous ulcers, dermatitis
Older Child and Adult
- Signs and symptoms are commonly related to nutritional or secondary deficiencies resulting from disease.
- Anemia, vitamin deficiency (A, D, E, K)
- Hypoproteinemia with edema
- Hypocalcemia, hypokalemia, hypomagnesemia
- Hypoprothrombinemia from vitamin K deficiency
- Disaccharide (sugar) intolerance
- Osteoporosis due to calcium deficiency
- Anorexia, fatigue, weight loss.
- May have colicky abdominal pain, distention, flatulence, constipation, and steatorrhea.
Diagnostic Evaluation
- Small bowel biopsy, which demonstrates characteristic abnormal mucosa.
- Hemoglobin, folic acid, and Vitamin K levels may be reduced.
- Prothrombin time may be prolonged.
- Elevated immunoglobulin (Ig) A endomysium antibodies and IgA anti-tissue transglutaminase antibodies.
- Total protein and albumin may be decreased.
- 72 hour stool collection for fecal fat is increased.
- D-xylose absorption test – decreased blood and urine levels.
- Sweat test and pancreatic function studies may be done to rule out cystic fibrosis in child.
Therapeutic Intervention
- Dietary modifications includes a lifelong gluten-free diet, avoiding all foods containing wheat, rye, barley, and possibly, oats.
- In some cases, fats maybe reduced.
- Lactose and sucrose may be eliminated from diet for 6 to 8 weeks, based on reduced disaccharidase activity.
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. People with celiac disease should always read food ingredient lists carefully to make sure the food does not contain gluten.
Allowed Foods | ||
---|---|---|
amaranth arrowroot buckwheat cassava corn flax Indian rice grass Job’s tears | legumes millet nuts potatoes quinoa rice sago | seeds sorghum soy tapioca teff wild rice yucca |
Foods To Avoid | ||
wheat
| barley rye triticale (a cross between wheat and rye) | |
Other Wheat Products | ||
bromated flour durum flour enriched flour farina | graham flour phosphated flour plain flour | self-rising flour semolina white flour |
Processed Foods that May Contain Wheat, Barley, or Rye* | ||
bouillon cubes brown rice syrup candy chips/potato chips cold cuts, hot dogs, salami, sausage communion wafers | French fries gravy imitation fish matzo rice mixes sauces | seasoned tortilla chips self-basting turkey soups soy sauce vegetables in sauce |
* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
Nursing Intervention
- Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status.
- Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as protein, fats, vitamins, and minerals.
- Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing.
- Provide parenteral nutrition as prescribed.
- Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown.
- Encourage small frequent meals, but do not force eating if the child has anorexia.
- Use meticulous hand washing technique and other procedures to prevent transmission of infection.
- Assess for fever, cough, irritability, or other signs of infection.
- Teach the parents to develop awareness of the child’s condition and behavior; recognize changes and care for child accordingly.
- Explain that the toddler may cling to infantile habits for security. Allow this behavior, it may disappear as physical condition improves.
- Stress that the disorder is lifelong; however, changes in the mucosal lining of the intestine and in general clinical conditions are reversible when dietary gluten is avoided.