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Celiac Disease and Autoimmune-Associated Conditions
« Gepost op: september 29, 2013, 15:44:02 »
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Celiac Disease and Autoimmune-Associated Conditions
Eugenia Lauret and Luis Rodrigo

Gastroenterology Unit, Central University Hospital of Asturias (HUCA), Celestino Villamil, 33006 Oviedo, Principality of Asturias, Spain
Received 10 May 2013; Accepted 20 June 2013
Academic Editor: Anne Astier

Copyright © 2013 Eugenia Lauret and Luis Rodrigo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Celiac disease (CD) is frequently accompanied by a variety of extradigestive manifestations, thus making it a systemic disease rather than a disease limited to the gastrointestinal tract. This is primarily explained by the fact that CD belongs to the group of autoimmune diseases. The only one with a known etiology is related to a permanent intolerance to gluten. Remarkable breakthroughs have been achieved in the last decades, due to a greater interest in the diagnosis of atypical and asymptomatic patients, which are more frequent in adults. The known presence of several associated diseases provides guidance in the search of oligosymptomatic cases as well as studies performed in relatives of patients with CD. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type 1 diabetes mellitus (T1D); others share pathogenic mechanisms, and yet, others are of unknown nature. General practitioners and other specialists must remember that CD may debut with extraintestinal manifestations, and associated illnesses may appear both at the time of diagnosis and throughout the evolution of the disease. The implementation of a gluten-free diet (GFD) improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the GFD contributes to its disappearance. In other disorders, like T1D, this allows a better control of the disease. In several other complications and/or associated diseases, an adequate adherence to a GFD may slow down their evolution, especially if implemented during an early stage.

Table 1: Celiac disease and associated autoimmune diseases.

2. Immunogenetics of Celiac Disease
Figure 1:
Gluten has a dual effect on the small intestine mucosa. Innate response (left). Toxic peptides, such as the 19-mer, induce an unspecific immune response characterized by the presence of IL-15 produced by the enterocytes, that in turn activates the NF-B in the adjacent cells    etc.etc.

3. Autoimmune Disorders in Celiac Disease
        3.1. Associated Autoimmune Liver Disease
               A variety of hepatobiliary disorders have been described in CD. Liver changes were    etc.etc.

        3.1.1. Primary Biliary Cirrhosis
                 In 1978, Logan et al. described the first cases   etc.etc.
        3.1.2. Autoimmune Hepatitis
                 A potential association between CD and AIH has also been  etc.etc.

        3.1.3. Primary Sclerosing Cholangitis
                 The association between CD and PSC was initially    etc.etc.

        3.1.4. Others
                  Nonalcoholic Fatty Liver Disease
                  Non-alcoholic fatty liver disease (NAFLD)   etc.etc.

                  Wilsonís Disease
                  In a recent study, in which serological    etc.etc.     

                  Budd Chiari Syndrome
                  There are also reported cases of    etc.etc.

3.2. Associated Autoimmune Endocrine Diseases
           3.2.1. Type 1 Diabetes    etc.etc. 
           3.2.2. Thyroid Diseases    etc.etc.
           3.2.3. Addisonís Disease    etc.etc.

3.3. Associated Autoimmune Dermatological Diseases
           3.3.1. Dermatitis Herpetiformis   etc.etc.
                    Figure 2:
                    Custry DH lesions in both knees.
                    Figure 3:
                    Several evolutive DH lesions in left shoulder and back

           3.3.2. Others
                     Some cases of alopecia areata associated   etc.etc.

3.4. Associated Autoimmune Neurological Diseases
           The first study of patients with CD (confirmed by biopsy) and a neurological   etc.etc.

3.5. Associated Rheumatological Disorders and Connective Tissue Diseases
           3.5.1. Sjogrenís Syndrome   etc.etc.
           3.5.2. Systemic Lupus Erythematosus  etc.etc.
           3.5.3. Juvenile Idiopathic Arthritis and Rheumatoid Arthritis   etc.etc.

3.6. Miscellaneous
           3.6.1. Cardiological Diseases     etc.etc. 
           3.6.2. Psoriasis   etc.etc.
           3.6.3. SarcoÔdosis   etc.etc.
           3.6.4. Hematological Disorders   etc.etc.
           3.6.5. Thromboembolic Phenomena    etc.etc.
           3.6.6. Pancreatic Disease    etc.etc.
           3.6.7. Microscopic Colitis    etc.etc.

4. Enteropathy-Associated T-cell Lymphoma and Celiac Disease

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