February 18, 2021

Malnutrition and Celiac: Understanding comorbidity and Diagnostic Applications

Celiac disease as we know today was discovered by the Greeks, and they named it after the inflammation of the bowels. The condition is prevalent among all age groups and is caused by autoantigen’s trigger by the consumption of Gluten protein present in wheat, rye, barley, and other grains.

The disease’s prevalence is 1% globally, of which India shares the prevalence 1.54% by serology and 1.04% by histology. Usually, the condition is known to be hereditary, but in chronic cases, which happens primarily due to lack of awareness of improper diagnosis or camouflaging of symptoms due to other comorbidities that the intestines are swelled up and the inner lining (villi) is destroyed, thereby causing complications indigestion, bowels, and overall metabolism.

The association of Celiac disease is prevalent with ailments like that of the liver, renal and gastrointestinal origin and can get manifold if there’s any aggravation by tropical infection. However, the most deadly combination does arise when Diabetes comes as a potent partner with Celiac Disease. India shares the most significant burden of Diabetic patients, and the comorbidity ranges from diet complications to abnormal hormone levels. Malnutrition which is endemic to the Indian population plays a crucial role in increasing the comorbidities with stunted growth, chronic diarrhea, and underweight. Around 26%-49% of Indian children presenting with chronic diarrhea are diagnosed with Celiac Disease in tertiary care hospitals. Numerous Indian studies on children have shown the prevalence of Celiac disease with various ailments varying from 1in 96 to 1 in 120. The children’s staple food is never a concern, as either wheat or rice is the principal culprit in consuming gluten in the diet. Nearly three-quarters can be ascribed to the Celiac disease itself, proliferative lymph disease, esophageal cancer, other small-intestine malignancy, or associated conditions such as hyposplenism and fibrosing alveolitis. Still, thankfully there has been no mortality recorded associated only with Celiac Disease. Although there’s no complete treatment for chronic cases, for all other acute conditions and comorbid conditions, the road to recovery requires the patient to be introduced to the consumption of a Gluten-Free Diet (GFD) over a while.

Tests like the Antiendomysial antibody (EMA) test, Tissue transglutaminase (tTG) based test, and Deamidated Gliadin peptide (DGP) test have formed the bulk of Celiac Serology. Experts these days have been advocating the combined use of serology and biopsy because of the limitations of both the testing domains. While the duodenal biopsy is the gold standard for testing Celiac Disease, it is limited to late diagnosis, and hence for early detection, the serological kits take predominance. J Mitra envisages providing the most affordable and easy-to-use ELISA kits for Celiac diagnosis. Simultaneously, both RDT or ELISA hold an advantage over the Anti-endomysial test (EMA) as they are not labor-intensive and don’t require any waiting period for the patients. To add to the Lab and the patient’s benefit, the ELISA test provided by J Mitra also has the option of reporting in both Semi-Quantitative and Quantitative modes.

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