What is celiac disease | Gastrointestinal system diseases | NCLEX-RN | Khan Academy



the name celiac disease doesn't actually tell us much about what the disease dots but there's another name that I think is a little bit more informative and that's gluten sensitive and taro patty in taro refers to small intestine and path u refers to disease so there's a disease of the small intestine that's caused by gluten it's also important to note that celiac disease is an autoimmune disease that is the immune system is attacking the small intestine we don't actually know why that's happening but we do know that some people have a genetic predisposition towards developing the disease we also know that people who have celiac disease are more likely to develop other autoimmune diseases as well such as type 1 diabetes or thyroid disease and we know that it's more common in people who are Down syndrome now even though we don't exactly know why the immune system is attacking the small intestine we can still kind of look at the pathophysiology and what's exactly going on in there now remember that gluten is composed of two different proteins there's glidin and that is gluten in will mostly focus on glidin now let's say you eat something that contains gluten that gluten will eventually make its way into the small intestine and here I kind of have a diagram of the different layers of the small intestine once it reaches this point for some reason your body will start to produce antibodies against the glidin this will then recruit all sorts of lymphocytes or white blood cells into your small intestine because you have a lot of lymphocytes and antibodies in your small intestine we say that there's inflammation in there so it's almost as if there's like a warzone going on in your small and test and that warzone kind of causes damage to the wall of the small intestine now remember that the wall is responsible for absorbing food and water so the process of absorption will be disrupted for example you can't really absorb much water anymore that water will just end up in your stools in a condition simply known as diarrhea similarly you can't absorb that's very well either and that will manifest in your stools in a condition known as steatorrhea and finally you may be unable to absorb iron or vitamin b12 as a result you may start to experience anemia so these are some of the major symptoms associated with problems and absorb but there's actually one more symptom that's not really associated with absorption let's say that here we have the body of someone who has celiac disease and they've eaten something that contains gluten in it all of a sudden they may start to see these rashes and blisters forming on their abdomen and their arms these rashes and these blisters are going to be extremely itchy this is a condition known as dermatitis herpetiformis it's not too common it affects about 10% of people who have celiac disease but it's one of the many symptoms that doctors may look for when diagnosing the disease now speaking of diagnosis I want to talk a little bit more about how some doctors can determine if someone has celiac disease first what they'll do is they'll determine if you have a higher probability or low probability of developing the disease they'll determine this by looking at your family history because remember that people have a genetic predisposition towards developing it if they see a lot of family members having the disease then they may order what's called a biopsy a biopsy is when we collect a small sample of the tissue that we're interested in after you collect that sample you then look at it under a microscope to see if it looks healthy or not the way we collect this tissue is through a procedure called an upper endoscopy they basically take this camera that looks like a tube called an endoscope and they put it through your mouth down your esophagus through your stomach and then eventually into your small intestine because it's a camera the doctors can then actually see what's going on in the small intestine and they can collect that sample now let's say you may have a low probability instead if for example you don't have a lot of family members who have celiac disease or even any other autoimmune disease you may not want to subject the patient to this really invasive procedure so first what we'll do is a few blood tests we're mostly going to be looking for different antibodies that are characteristic of celiac disease because remember that this is an autoimmune disease so there are five classes of antibodies called IgA IgG IgE IgG and IgM we're mostly going to look for antibodies that fall into the iga category and there are two different types there is anti tissue transglutaminase and there's anti endomysium if these blood tests turn out positive that is you have these antibodies in your system then there's a chance that you may have celiac disease so then the doctrine may go on to continue with a biopsy just to confirm things now let's take a look at that biopsy in a little bit more detail so here we have two different pictures of the small intestine under the microscope on the right we have a healthy small intestine and on the Left we have the small intestine of someone who has celiac disease first I want to highlight what's good about the healthy you'll notice that it has these finger-like protrusions called villi these guys are responsible for absorption in the small intestine there are also these grooves between the villi known as crypts in the diseased sample you'll notice that these villi are actually blunted this is known as villous atrophy in addition those crypts are actually elongated so they're becoming a little bit bigger and that's because all sorts of cells are dividing there so we call this crypt hyperplasia so it's kind of like the mountains of the villi are getting smaller and the valleys of the crypts are getting deeper now there's one more comparison picture that I want to show you as well in this case on the Left we have someone who is healthy and the right we have someone who has celiac disease now remember that in celiac disease you have a lot of inflammation in the small intestine that means that you have a lot of lymphocytes in there so it would be a good idea to actually look for these lymphocytes so you'll see these kinds of blobs that are in the villi and the small intestine right and the celiac disease tissue actually has a lot more of them now these blobs are corresponding to the lymphocytes and it's pretty clear in this picture that there are way more lymphocytes in in the diseased tissue than in the healthy and these are really the main signs that we look for with regards to celiac disease and if the tissue sample shows this then that's how we can diagnose it but diagnosing it is one thing I mean how can we really treat it well unfortunately there aren't really many medicines or procedures available to treat celiac disease once the glidin from the gluten makes its way into the body it's pretty difficult to stop the antibodies from marking them so ultimately the best thing that anyone can do is to simply go on a gluten-free diet now usually these Lewton free diets are pretty strict but I think that now given that there is this rise of gluten-free diets becoming a little bit more easy for people to maintain these diets as long as you don't consume gluten then you should be okay even if you have celiac disease

20 comments

  1. I am looking for people with a sibling with celiac disease (or another autoimmune disease) for a research project based at the University of Surrey. If you are interested the questionnaire is here: http://tinyurl.com/yd7fetst.

  2. I appreciate the content but I would have liked more information on the pathophysiology. I have looked elsewhere (UptoDate, Robins and Osmosis) and would like to share my findings in dot-point form:

    -> Gluten ingested
    -> Once it reaches the duodenum, it has already been broken up into gliadin and glutenin
    -> On the mucus layer that lines the GIT wall, secretory IgA binds to gliadin. Normally, the body should attack this complex, however this does not occur.
    -> The complex binds to transferrin receptors on the enterocytes (an increased number of such receptors in those with coeliac) and allows the complex to travel through the cell and into the lamina propria where gliadin is separated from IgA
    -> Once in the lamina propria, an enzyme known as 'tissue transglutaminase (tTG)' acts on gliadian and the product is 'deamidated gliadine'.
    -> Deamidated gliadine is recognised by and bound to MHC II receptors on macrophages, more specifically, the HLA-DQ2 and/or HLA-DQ8 subtypes.
    -> This triggers an immune response which destroys enterocytes, leading to malabsorption, thus symptoms such as anaemia, steatorrhea and diarrhoea

  3. Great video! I have Celiac Disease, I was diagnosed at 16.
    Let's say you start a gluten-free diet, are the vili able to heal?
    I am 23 and I struggle so much eating a gluten-free diet but I recognize the importance and this video really helped me realize I should probably stick to it 😩

  4. Very helpful! I needed this type of explanation for my nutrition and diet therapy report! Do keep on making this type of videos! God bless you!

  5. Hi,
    I've started an educational Youtube account specifically designed to help understand biology based topics and to explore all things cool about science. I would greatly appreciate it if you could  have a look at one of my videos and give any constructive comments on it. Thank you !

  6. I was diagnosed with the Celiac disease after I had a camera put down when I was like 13, I stuck to the diet for about 3 months and then started eating wheat again because it didn't hurt or change my body in any way, I told the doctor years ago and he said that if it doesn't hurt or cause discomfort in any way, then its okay to keep eating wheat and gluten, I started getting consistent stomach cramps a few weeks ago and if I go without food for about 2 hours I'll start feeling really sick though. Not really sure what to do because I'm a poor uni student and I can't really afford to stop eating gluten, I live on pasta.

  7. Why is there a rise in gluten free food?
    Because there is a rise in gluten-like hypersensitivity.
    There has gradually been an increase in the use of Glyphosate (aka Roundup) on food crops, especially directly on the plant just before harvest like in grains.
    I postulate that this is what is causing increased hypersensitivity reactions from their cross-reactivity with gluten and other food products.
    This increase in what people call Gluten Intollerance is really Glyphosate hypersensitivity in a lot of cases. It accumulates in your foods, especially normal bread. Get ORGANIC Bread/Flour. So cheap, so easy so worth it for your long term immunological health.
    <3
    http://www.i-sis.org.uk/Why_Glyphosate_Should_be_Banned.php

  8. We don't know why there is an attack in these disorders but I have a feeling it is the result of generations of Candida Albicans (a fungus we all have in our bodies and beyond) being passed down. Some of us have it worse than others. A grain-yeast free diet is best but hard to live out. Worth it but still hard to eat that clean. I have a serious disorder around donuts (mainly Krispy Kremes:). When I pass by that case and something comes over me. I have found I can eat them without problems in packaged donuts… maybe it is the preservatives? I want to learn how to make bread without yeast with grains like spelt, quinoa, rice, because of a wheat allergy I have had all my life. It causes swelling in my sinuses and eyes.

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