Concorde Career College Celiac Disease Diarrhea and Constipation Discussion

Description

A 19-year-old co-ed presents with increasing diarrhea and constipation over the last two weeks with a history of celiac disease.What is the role of immunity and celiac disease?

Celiac is an autoimmune disorder that only involves the mucosa of the small bowel. The immune system responds abnormally to gluten as a foreign invader in individuals with celiac disease. It triggers the immune response in the small intestines leading to chronic inflammation, and damage to the small intestine’s lining, preventing the absorption of nutrients and causing gastrointestinal symptoms such as diarrhea, abdominal pain, bloating, and malabsorption problems. Significant advances in understanding the role of the adaptive immune mechanism in response to gluten peptides for celiac disease, but the complete series of pathogenic events responsible for the development of the tissue lesion remains less specific (Dunne, Byrne, Chirdo & Feighery, 2020).

What is the effect of gluten on celiac disease?

The effect of gluten on celiac disease is significant because a peptide derived from gluten called gliadin causes a primary trigger for the immune system to react by attacking the lining of the small intestine (Posner & Haseeb, 2022). Currently, the only treatment for celiac disease is a gluten-free diet. Addressing celiac disease through a strict gluten-free diet can help alleviate the symptoms by reducing inflammation and allowing the intestines to heal over time.

Describe the pathophysiology of the diarrhea and constipation.

Diarrhea caused by celiac disease is due to the immune system responding to gluten by attacking the small intestine’s lining, causing inflammation and damage to the villi – finger-like projections that aid nutrient absorption leading to the malabsorption of nutrients and water. The inflammatory process also increases intestinal permeability triggering an osmotic effect, drawing water into the intestines and resulting in diarrhea. Inflammation and damage to the intestinal lining can also lead to hypersecretion of intestinal fluids. This excessive fluid secretion and malabsorption contribute to the watery consistency of diarrhea seen in celiac disease. The stools might be liquid or semiformed, light tan or gray, and oily or frothy with a foul odor.

Constipation in celiac disease is due to chronic inflammation and damage to the intestinal nerves and muscles, leading to reduced intestinal motility and slower movement of stool that result in constipation. Dietary factors are another concern due to gluten restriction diets consuming a low-fiber diet contributing to constipation. The autoimmune response in celiac disease can also affect the nervous system, disrupting the communication between the enteric and intestines nervous system and impacting bowel movements resulting in constipation.

References

Posner, E. B., & Haseeb, M. (2022). Celiac Disease. In StatPearls. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK441900.

Dunne, M. R., Byrne, G., Chirdo, F. G., & Feighery, C. (2020). Coeliac Disease Pathogenesis: The Uncertainties of a Well-Known Immune-Mediated Disorder. Frontiers in immunology, 11, 1374. https://doi.org/10.3389/fimmu.2020.01374

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