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Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye, spelt and barley. [10]
For people with celiac disease, a lifelong strict gluten-free diet is the only effective treatment to date; [23] [69] For people diagnosed with non-celiac gluten sensitivity, there are still open questions concerning for example the duration of such a diet.
Reported symptoms of NCGS are similar to those of celiac disease, [30] [31] with most patients reporting both gastrointestinal and non-gastrointestinal symptoms. [29] [32] In the "classical" presentation of NCGS, gastrointestinal symptoms are similar to those of irritable bowel syndrome, and are also not distinguishable from those of wheat allergy, but there is a different interval between ...
In 1924, Sidney V. Haas (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the banana diet. [2] [3] Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died. [4]
Based on histologic findings the differential diagnosis of pediatric autoimmune enteropathy is graft-versus-host disease, Crohn's disease, and food sensitivity enteropathies such as celiac disease and lactose intolerance. [6] Lactose intolerance should be excluded in infants with intractable diarrhea.
Celiac disease affects ~1% of the population in most parts of the world. [3] Ninety to one hundred percent of patients with coeliac disease have inherited genes at the HLA-DQ locus that encode HLA-DQ2 and/or HLA-DQ8 serotype proteins. [12] About 2–3% of individuals who inherit these HLA-DQ2 and/or HLA-DQ8 serotypes develop coeliac disease. [10]
In these people, the gluten-free diet is demonstrated as an effective treatment, [7] [8] [9] but several studies show that about 79% of the people with coeliac disease have an incomplete recovery of the small bowel, despite a strict gluten-free diet. [10] This is mainly caused by inadvertent ingestion of gluten. [10]
The mainstay of treatment involves open or laparoscopic surgery approaches to divide, or separate, the median arcuate ligament to relieve the compression of the celiac artery. [5] This is combined with removal of the celiac ganglia and evaluation of blood flow through the celiac artery, for example by intraoperative duplex ultrasound.