Celiac disease and the surgeon (2023)

Table of Contents
Article preview The American Journal of Surgery Abstract Background Methods Results Conclusion Introduction Section snippets Methods Etiology Conclusions Declaration of competing interest References (99) Clin Res Hepatol Gastroenterol J Gastrointest Surg Dig Liver Dis Gastrointest Endosc Gastroenterology Medicine Am J Surg Am J Med Am J Med Sci Am J Gastroenterol Gastrointest Endosc Dig Liver Dis Dig Liver Dis Gastroenterology Gastroenterology Celiac disease: a comprehensive current review BMC Med Current and emerging therapies for coeliac disease Nat Rev Gastroenterol Hepatol Cysteinyl leukotrienes mediate lymphokine killer activity induced by NKG2D and IL-15 in cytotoxic T cells during celiac disease J Exp Med Global prevalence of celiac disease: systematic review and meta-analysis Clin Gastroenterol Hepatol Incidence of celiac disease is increasing over time: a systematic review and meta-analysis Am J Gastroenterol Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms Am J Gastroenterol Trends and racial/ethnic disparities in gluten-sensitive problems in the United States: findings from the national health and nutrition examination surveys from 1988 to 2012 Am J Gastroenterol Update on serologic testing in celiac disease Am J Gastroenterol Molecular biomarkers for celiac disease: past, present and future Int J Mol Sci ACG clinical guidelines: diagnosis and management of celiac disease Am J Gastroenterol Celiac disease: fallacies and facts Am J Gastroenterol Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet Aliment Pharmacol Ther Recent advances in celiac disease and refractory celiac disease Inflammatory bowel disease in patients with celiac disease Inflamm Bowel Dis Association of intussusception and celiac disease in adults Dig Dis Sci Celiac disease presenting as acute colonic pseudo obstruction J Med Liban Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease J Clin Gastroenterol Surgical aspects of celiac disease Am Surg Increased risk of surgery in undiagnosed celiac disease Dig Dis Sci Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care Ann Surg Gastrointestinal motility disturbances in celiac disease J Clin Gastroenterol Motility disorders in patients with celiac disease Scand J Gastroenterol Delayed gastric emptying does not normalize after gluten withdrawl in adult celiac disease Scand J Gastroenterol Decreased risk of celiac disease in patients with Helicobacter pylori colonization Am J Epidemiol The celiac stomach: gastritis in patients with celiac disease Aliment Pharmacol Ther Helicobacter pylori infection in patients with celiac disease Am J Gastroenterol The liver in celiac disease Hepatology Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation Liver Int The risk of acute and chronic pancreatitis in celiac disease Dig Dis Sci Patients with celiac disease have an increased risk for pancreatitis Clin Gastroenterol Hepatol Risk of pancreatitis in 14,000 individuals with celiac disease Clin Gastroenterol Hepatol Impaired intestinal cholecystokinin secretion, a fascinating but overlooked link between coeliac disease and cholesterol gallstone disease Eur J Clin Invest Inflammatory bowel disease and celiac disease: overlaps and differences World J Gastroenterol Phenotype and clinical course of inflammatory bowel disease with Co-existent celiac disease J Crohn's Colitis Cited by (0) Recommended articles (6) FAQs Videos
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The American Journal of Surgery

Volume 224, Issue 1, Part B,

July 2022

, Pages 332-338

Author links open overlay panelJon S.ThompsonaPersonEnvelopePeterMannonb

Abstract

Background

Celiac disease (CD), a disorder characterized by intestinal inflammation and villus atrophy, has protean manifestations. CD is being diagnosed more frequently but is often undiagnosed when encountered by surgeons. Our aim was to review aspects of CD that are relevant to the surgeon.

Methods

A PubMed database search was performed for articles published between January 2000 and December 2021 related to surgical issues in CD.

Results

CD is associated with a variety of conditions throughout the gastrointestinal tract. There is an increased risk of a variety of malignancies, including small intestinal tumors. Patients with CD are at an increased risk for operations for common problems such as appendicitis. Patients with undiagnosed CD undergoing operation may develop symptoms leading to diagnosis postoperatively.

Conclusion

Surgeons should be aware of CD associated conditions, the risk of malignancy and confounding symptoms. Undiagnosed CD should be suspected if malabsorptive symptoms develop following operation.

(Video) Should Patients with Morbid Obesity be Tested for Celiac Disease Before Surgery? - News

Introduction

Celiac disease (CD) is a disorder induced by the ingestion of rye, wheat and barley in genetically susceptible individuals and characterized by intestinal inflammation and villus atrophy. Currently, the prevalence of CD in the United States is approximately 0.7%. However, many patients with CD are undiagnosed when encountered by surgeons. Furthermore, there are a number of surgical conditions associated with CD. Thus, awareness of this disorder by surgeons is important.

The purpose of this narrative review is to give a brief overview of the current understanding of CD, including its diagnosis and management. Attention will then be paid to specific surgical issues.

Section snippets

Methods

A PubMed database search was performed according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles published between January 2000 and December 2021 related to surgical issues in CD identified by the authors were sought. The database was last accessed January 31, 2022. The key search terms were “celiac disease AND operation NOT celiac artery NOT celiac lymph node NOT celiac plexus” (n=1480) and “celiac disease AND malignancy NOT celiac artery

Etiology

CD is mediated by gut mucosal T cells that are activated by gluten peptides that bind to the disease-specific HLA molecules HLA-DQ2 or DQ-8 on antigen presenting cells (APCs). Dietary gluten (in monomeric (gliadin) and polymeric (glutenin) forms) is incompletely digested in the gut lumen due to a high proline and glutamine content.1 The large gluten peptides can enter the mucosa where they are deamidated by tissue transglutaminase (TTG) which further increases the affinity of these peptides for

Conclusions

CD is being diagnosed more frequently and such patients are likely to be encountered by surgeons. CD has protean manifestations relevant to surgeons. There should be awareness of the associated conditions and confounding symptoms to guide surgical decision making. The risk of malignancy, particularly of the small intestine, should always be considered. Undiagnosed CD should be suspected if malabsorptive symptoms develop following operation, even procedures normally associated with malabsorption.

Declaration of competing interest

The authors have no relevant conflicts of interest related to this work.

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    FAQs

    Is celiac disease curable with surgery? ›

    There is no cure for celiac disease and the only treatment known to be effective is a gluten-free diet.

    Can celiac cause permanent brain damage? ›

    People living with Coeliac Disease (CD) have a higher risk of neurological damage according to a new study from the University of Sheffield. The study found that the brains of people living with CD showed evidence of damage to brain matter and cognitive deficit in the form of slowed reaction times.

    Can you be falsely diagnosed with celiac? ›

    Many patients are diagnosed as celiacs even without completing the whole diagnostic process, with consequent risk of misdiagnosis and delay in the evaluation of other diseases.

    What is the long term prognosis for celiac disease? ›

    Untreated celiac disease can lead to the development of other autoimmune disorders like type 1 diabetes and multiple sclerosis (MS), and many other conditions, including dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, ...

    Is Celiac a permanent disability? ›

    Celiac is a life-long medical condition that can be managed, but unfortunately not cured.

    How long does it take to reverse celiac damage? ›

    After you stop eating foods with gluten, your symptoms will likely get better in a few days. Your small intestine should heal completely in 3 to 6 months. Your villi will be back and working again. If you are older, it may take up to 2 years for your body to heal.

    Can celiac cause dementia? ›

    However, in patients with deficiency syndromes, extensive involvement of the small intestine with celiac disease is often evident. There are a number of reports of celiac disease associated with neuropathy, ataxia, dementia and seizure disorder.

    Does celiac disease affect memory? ›

    Many people with celiac disease report having “brain fog”, a form of cognitive impairment that can encompass disorientation, problems with staying focused and paying attention, and lapses in short-term memory.

    Can celiac cause MS? ›

    Interestingly, it has been previously reported that celiac disease is associated with nerve damage, also known as neuropathy, and to an increased risk of nerve-related disorders like multiple sclerosis (MS), a chronic, progressive neurodegenerative disease that results from the attack to the nervous system by the ...

    What is the biggest damage of celiac disease? ›

    Celiac disease damages the villi, leaving your body unable to absorb nutrients necessary for health and growth. Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

    Does celiac worsen with age? ›

    Research published in the Annals of Medicine in 2010 found that celiac disease rates rose as people aged. Researchers analyzed stored blood samples from more than 3,500 people that had been taken in 1974 and then again in 1989. In 1974, one in 501 people showed blood markers for celiac disease.

    What cancers are associated with celiac disease? ›

    There are 3 types of cancer associated with celiac disease: enteropathy-associated T-cell lymphoma (EATL), non-Hodgkin's lymphoma, and adenocarcinoma of the small intestine. It is important to remember, however, that developing cancer due to celiac disease is quite rare.

    How accurate is celiac biopsy? ›

    The physician eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine, and then takes samples of the tissue using small instruments passed through the endoscope. Biopsy remains the most accurate way to diagnose celiac disease.

    What is celiac disease commonly misdiagnosed as? ›

    Despite awareness efforts, celiac disease is often confused with other gluten-related disorders — like non-celiac gluten sensitivity (NCGS) or a wheat allergy. Both seem similar to celiac disease, but are different conditions.

    How accurate is blood test for celiacs? ›

    The tTG-IgA test is the preferred celiac disease serologic test for most patients. Research suggests that the tTG-IgA test has a sensitivity of 78% to 100% and a specificity of 90% to 100%.

    Is there any financial help for celiac disease? ›

    If your symptoms of celiac disease have lasted for a year or more and they have resulted in you being unable to work, then you might be eligible for Social Security disability (SSDI/SSD) benefits or Supplemental Security Income (SSI) benefits.

    Is celiac considered special needs? ›

    Individuals with celiac disease have different needs at different times in their life. Because of these special needs, celiac disease is considered a disability under the Americans with Disabilities Act.

    How long does it take the small intestine to heal from celiac disease? ›

    Improvements begin within weeks of starting the diet and the small intestine is usually completely healed—meaning the villi are intact and working—in 6 to 18 months. (It may take up to 2 years for older adults.)

    How do you flush gluten out of your body? ›

    Drink plenty of water. Water is one of the best things we can ingest to flush out our digestive tract and keep it working optimally. And, if you struggle with constipation, it can help moisten stool so that it passes more easily and quickens elimination.

    Is there a pill for celiac? ›

    There is no medication that treats celiac disease. To avoid the health problems that it can cause, you'll need to go completely gluten-free.

    What does celiac do to the brain? ›

    On cognitive tests, celiac patients showed slower reaction time. There were higher indications of poor mental health including anxiety, depression, thoughts of self-harm and health-related unhappiness. Brain scans showed increased damage to cerebral white matter similar to effects of aging.

    Can celiac affect mental health? ›

    Anxiety, depression and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life. While aspects of these conditions may improve within a few months after starting a gluten-free diet, some patients continue to suffer from significant psychological morbidity.

    Does your brain need gluten? ›

    A new study tested whether there is truth to the idea that gluten hinders cognition or negatively affects memory or attention span. Researchers found that in the absence of celiac disease, restricting gluten to maintain cognitive function is not necessary.

    Can celiac disease change your personality? ›

    Research shows that untreated celiac disease can impact emotions, cognitive ability, behaviors, and more. Anxiety, depression and fatigue are common issues reported in celiac disease patients prior to diagnosis.

    Do people with celiac have a lower life expectancy? ›

    Celiac disease may affect life expectancy

    A recent study published in JAMA found a small but significant increased risk of mortality in people with CD. Interestingly, people with CD were at an increased risk of death in all age groups studied, but mortality was greater in those diagnosed between the ages of 18 and 39.

    Can you donate blood with celiac? ›

    Can a person with celiac disease on gluten-free diet give blood? Yes, a person with celiac disease can donate blood.

    Does celiac cause blurred vision? ›

    Celiac disease.

    Celiac disease comes with numerous symptoms and blurred vision happens to be one of them. To learn about the other 200+ ailments associated with the condition, check out “Celiac Disease Symptoms: List of 281 Ailments.”

    Is Celiac a neurological disease? ›

    Celiac disease (CD) can be considered a complex multi-organ disorder with highly variable extra-intestinal, including neurological, involvement. Cerebellar ataxia, peripheral neuropathy, seizures, headache, cognitive impairment, and neuropsychiatric diseases are complications frequently reported.

    Can celiac have neurological symptoms? ›

    Celiac disease (CD) long has been associated with neurologic and psychiatric disorders including cerebellar ataxia, peripheral neuropathy, epilepsy, dementia, and depression. Earlier reports mainly have documented the involvement of the nervous system as a complication of prediagnosed CD.

    Can celiac disease lead to surgery? ›

    Celiac disease, characterized by intestinal inflammation and malabsorption, occurs in 1 per cent of the population and is often undiagnosed. These patients are at increased risk for surgical procedures resulting from symptoms, associated intestinal disorders, and malignancy.

    What is the best treatment for celiac disease? ›

    The only treatment for celiac disease is to follow a strict gluten-free diet for life. This means avoiding foods and beverages that gluten, a protein found in wheat, rye, barley, and triticale ( a hybrid of wheat and rye.)

    How do you cut out celiac disease? ›

    A gluten-free diet is the only treatment if you've been diagnosed with celiac disease. You'll have to avoid gluten for the rest of your life. Even the slightest amount will trigger an immune system reaction that can damage your small intestine.

    Can celiac disease be caused by surgery? ›

    Celiac disease can be triggered by upper abdominal surgery, such as vagotomy, oesophagectomy, pancreaticoduodenectomy, and gastrojejunal anastomosis.

    What is the biggest damage of celiac disease? ›

    Celiac disease damages the villi, leaving your body unable to absorb nutrients necessary for health and growth. Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

    Why are so many people getting celiac disease? ›

    “In part, the incidence of celiac disease has risen because of improved awareness of the disease and more accurate and less invasive diagnostic testing, for example blood testing,” said study author Gilaad Kaplan, MD, scientific director of Digestive Health Strategic Clinical Network, Alberta Health Services.

    Is there a pill to stop celiac disease? ›

    There is no medication that treats celiac disease. To avoid the health problems that it can cause, you'll need to go completely gluten-free.

    Is there a pill to help celiac disease? ›

    Drug therapy

    For example, latiglutenase is taken with meals and contains enzymes that break down gluten in the stomach, rendering the protein non-toxic to patients with celiac disease.

    Is there any new treatment for celiac disease? ›

    Chugai is conducting a phase 1 clinical trial for DONQ52, an investigational medication designed to target an immune complex known to cause celiac disease symptoms. DONQ52 is expected to also protect the small intestine against damage caused by gluten exposure.

    Can celiacs eat chocolate? ›

    If you are diagnosed with coeliac disease, it is extremely important that you stick to your gluten free diet, avoiding any foods that contain gluten, including chocolate.

    Can celiacs eat potatoes? ›

    Many foods, such as meat, vegetables, cheese, potatoes and rice, are naturally free from gluten so you can still include them in your diet. A dietitian can help you identify which foods are safe to eat and which are not.

    Can celiacs eat rice? ›

    People with coeliac disease can safely eat many common plants, seeds, grains, cereals and flour, including corn, polenta, potatoes, rice and soya. However they should avoid barley, wheat, rye, couscous and semolina as they contain gluten.

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