Place · Level 3 · Conditions
Coeliac disease
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In one pass Gliadin from wheat gluten reaches the small intestine. Educational content, not medical advice — consult a clinician.
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Chapter 1
The enzyme turns gliadin into antigen
酶把麦胶变成抗原
Gliadin from wheat gluten reaches the small intestine. The immune system should not treat it as an enemy. Dieterich 1997 identified the endomysial autoantigen: tissue transglutaminase (tTG). Gliadin is a preferred substrate of that enzyme — it deamidates gliadin and creates novel epitopes. Antibodies then face both the enzyme and the modified gliadin.
This is autoimmunity, not a soft line about being sensitive to bread. The digestive island covers absorptive surface. This island covers why that surface is taken apart by the self.
This is autoimmunity, not a soft line about being sensitive to bread. The digestive island covers absorptive surface. This island covers why that surface is taken apart by the self.
Chapter 2
Villi are flattened
绒毛被拆平
Lebwohl 2018: coeliac disease is small-intestinal damage, loss of absorptive villi and crypt hyperplasia, typically toward malabsorption. Diagnosis needs serology plus biopsy. Treatment is a strict gluten-free diet. Left running, there is also a layer of enteropathy-associated T-cell lymphoma risk.
What you can draw: the enzyme modifies gliadin → immunity faces the villus → the absorptive surface flattens. Iron lack, low calciferol, weight loss are consequences after that surface is taken apart, not three different diseases.
What you can draw: the enzyme modifies gliadin → immunity faces the villus → the absorptive surface flattens. Iron lack, low calciferol, weight loss are consequences after that surface is taken apart, not three different diseases.
Chapter 3
Not the gluten-free fashion
和时尚无麸质是两回事
The gluten-free fashion in the food world already has an island: in self-reported non-coeliac gluten sensitivity, Skodje 2018's crossover pointed symptoms more at fructans than gluten; in people without coeliac disease, long-term gluten restriction in Lebwohl 2017 was not tied to less coronary disease and may cut whole grains.
True coeliac disease must strictly avoid gluten because villi will be taken apart. Fashionable avoidance has no such enzyme and antibody. Do not merge the two problems into everyone should drop wheat. The oats island covers cross-contamination and the minority who react to avenin itself.
True coeliac disease must strictly avoid gluten because villi will be taken apart. Fashionable avoidance has no such enzyme and antibody. Do not merge the two problems into everyone should drop wheat. The oats island covers cross-contamination and the minority who react to avenin itself.
Chapter 4
The diet is treatment, not a menu
饮食是治疗, 不是菜单
Lebwohl writes a strict gluten-free diet as the established treatment. This island stops at the mechanism and that treatment discipline. It does not write recipes and it does not replace gastroenterology's biopsy and follow-up. If you suspect it, test first. Do not start avoiding gluten and then draw antibodies — once the diet has stopped, serology can go falsely negative.
References · 4
- Dieterich, W., Ehnis, T., Bauer, M., Donner, P., Volta, U., Riecken, E. O., & Schuppan, D. (1997). Identification of tissue transglutaminase as the autoantigen of celiac disease. Nature Medicine, 3(7), 797-801. Tissue transglutaminase is the endomysial autoantigen. Gliadin is a preferred substrate of the enzyme, giving rise to novel antigenic epitopes. 10.1038/nm0797-797
- Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018). Coeliac disease. The Lancet, 391(10115), 70-81. A strict gluten-free diet is the established treatment for celiac disease; diagnosis requires serology and biopsy. 10.1016/S0140-6736(17)31796-8
- Skodje, G. I., Sarna, V. K., Minelle, I. H., et al. (2018). Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology, 154(3), 529-539. A double-blind crossover trial implicating FODMAP fructans over gluten in many self-reported cases. 10.1053/j.gastro.2017.10.040
- Lebwohl, B., Cao, Y., Zong, G., et al. (2017). Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ, 357, j1892. Restricting gluten in people without celiac disease was not associated with lower cardiovascular risk and may reduce whole-grain intake. 10.1136/bmj.j1892