Introduction
The presentation of this guideline shows what is recommended towards coeliac disease (CD) (Lebwohl, 2018) control taking into consideration other disorders caused by gluten among children not exempting adults alike. The spread of the coeliac disease has increased rapidly along the past fifty years, and a lot of patients are yet to be diagnosed. With biopsy and serology included, testing in diagnostics is to be done with a diet containing gluten. Diagnosing coeliac disease has been founded on the cluster of data that is serological, clinical, and that is histopathological. For a number of children, the diagnosis is done exempting biopsy as long as there is the presence of criteria that is strict. Coeliac disease is normally treated by taking a diet that is free of gluten (GFD) that needs crucial education of the patient, follow-up, and motivation.
A lot of times, the response rate is slow, especially if the diagnosis of the coeliac disease occurs in adulthood (Esteve, 2018). Symptoms that are recurring or persistent create a need for the original diagnosis review, eliminating the diagnoses that are alternative, confirmation of adherence to a diet, which is serology, and review of the diet, along with a follow-up of the biopsy. Together with that, evaluation should be done to eliminate any complications of coeliac disease, which may include lymphoma or refractory coeliac disease. As gluten withdraws, the lesions on the skin clear also. Similarly, conditions that are minimally defined as the sensitivity of gluten that is non-coeliac (NCGS) and neurological manifestations that are sensitive to gluten like ataxia are also included.
Aim
This guideline aims at addressing the control of disorders related to gluten involving coeliac disease (CD), sensitivity to gluten that is non-coeliac (NCGS), and manifestations that are extra-intestinal and gluten-related (Alberto Rubio-Tapia, 2019).
Definition of Terms
The ingestion of gluten is connected to a number of disorders that are clinical, together referred to as disorders that are gluten-related, and they have, over time, become a relevant phenomenon of epidemiology. Other than the coeliac disease, the range of the disorders includes dermatitis herpetiformis and other disorders like ataxia that is sensitive to gluten and sensitivity to gluten that is non-coeliac.
- Gluten is the protein mass which is not soluble in water that is left when the dough of wheat is washed to eliminate albumins, starch, and other proteins that are soluble in water. Gluten and other proteins that are related to gluten are found in barley, rye, and wheat, and they are extensively used in the processing of food so as to make the dough have the baking properties desired, enhance texture and increase flavors.
- Coeliac disease is a multiple organ and chronic disease which attacks the small bowel in people that are genetically predisposed brought about by gluten ingestion. In past times, it was called coeliac sprue, non-tropical sprue, or enteropathy that is sensitive to gluten.
- Dermatitis herpetiformis (DH) (Collin, 2017) is an epidermal coeliac disease indication attributed by clusters of herpetiform of papules that are pruritic urticated, deposits of IgA in the dermal papillae that are granular and vesicles on the skin. The lesions of the skin ordinarily clear as gluten withdraw, but it is not so with all adults.
- Gluten ataxia is an in other way ataxia that is idiopathic sporadic in relation to coeliac serology that is positive, or that lacks enteropathy. Other explanations of ataxia that are alternative like disorders of genetics, phenomena of paraneoplastic, and ischaemia need for exclusion.
- Non-coeliac gluten sensitivity is attributed to symptoms likened to those of bowel syndrome that is irritable (IBS) and manifestation that is extra-intestinal, that occur after a few days or hours after eating food containing gluten, becoming better fast as gluten eliminates and retrogressing in a short time after the challenge of gluten. The elimination of both the allergy of wheat (WA) and coeliac disease is a pre-requisite for gluten that is non-coeliac suspicion while a patient continues with a diet containing gluten.
Assessment
- The patient group targeted by this assessment are those portraying symptoms of steatorrhea diarrhoea, failure to thrive, or loss of weight. Also, patients that exhibit signs and symptoms of anaemia, reflux oesophagitis, vague abdominal symptoms usually related to IBS, neuropathy, eosinophilic oesophagitis, depression, ataxia, osteoporosis and osteomalacia, short stature, outcomes of adverse pregnancy, unexplained liver transaminitis, and lymphoma (Leffler, 2015).
- Physical Assessment
- initial acute
Itchy rash, bloating, tiredness, loss of weight, anemia that is iron-deficient, constipation, gas, being depressed, and diarrhea.
- ongoing assessment
The review presently is timely and gives provision for an appraisal of different aspects that is thorough, showing the characteristics of celiac disease.
- Investigations – biochemistry, procedures
- Social history/issues
Celiac disease has no cure and endures throughout life. Celiac disease patients have to keep gluten out of their diet in order to manage their symptoms.
- Education needs (patient and parent/care-giver)
If one suspects that they have celiac disease, they are to consult with their doctor for testing and to determine whether a diet free of gluten is necessary or not. Similarly, it is not advisable to start a diet free of gluten just because one suspects a celiac disease because this may alter the results.
- Nutrition
Foods to avoid unless there are labeled as free of gluten specifically are; cookies, bread, cakes, pies, pasta, gravies, beer, sauces, and dressings.
Foods fit for consumption are; meat, seafood, poultry, eggs, dairy, grains that are free of gluten like rice, quinoa, millet and buckwheat, fruits, vegetables, legumes, nuts, herbs, healthy fats, and spices.
Management (consider using clinical algorithms)
Acute management
All products that contain wheat, rye, barley, or spelt have to be done away with not excepting any food like oats that are interbred.
Ongoing management
Challenges remaining include finding an understanding that is better concerning the phenotypes that are still not clear like seronegative and potential, slow responsive celiac disease. The identification of complementary or alternative treatments towards the diet that is free of gluten gives hope to patients who are much burdened by the restrictions of diet.
Follow-up / Review
Continual check that one is free of foods containing gluten. Celiac disease may lead to many worse side effects, including issues of digestion, deficiency in nutrition fatigue, and loss of weight if left untreated.
Special Considerations
Avoidance of eating foods with gluten. All products that contain wheat, rye, barley, or spelt have to be done away with not excepting any food like oats that are interbred.
Companion Documents
Celiac Disease guideline – https://www.andeal.org/vault/pq85.pdf
Support of NHS towards People having Coeliac Disease (CD) – https://www.coeliac.org.uk/document-library/2444-briefing-nhs-support-for-patients-with-coeliac-disease/
Links
Include web address
Evidence Table
Enteropathyassociated T-cell lymphoma, dermatitis herpetiformis, coeliac disease, gluten ataxia, neurocoeliac, coeliac neuropathy, non-coeliac gluten sensitivity, coeliac that is slow-responder, and refractory and seronegative coeliac diseases.
| Databases searched: | ☐ | CINAHL (Ebsco) | ☐ | Medline (Ebsco) | ☐ | Pubmed (NLM) | ☐ | Nursing (Ovid) | ☐ | Emcare (Ovid) |
| Keywords used: | Enteropathy associated T-cell lymphoma, dermatitis herpetiformis, coeliac disease, gluten ataxia, neurocoeliac, coeliac neuropathy, non-coeliac gluten sensitivity, coeliac that is slow-responder, and refractory and seronegative coeliac diseases. | |||||||||
| Search limits: | Coeliac disease, symptoms, and prevention, and the effects of gluten in foods. | |||||||||
| Other search comments: | Coeliac disease assessment and control. |
| References (including author, journal title, title, publication year, pages, volume, and issue) | Level of Evidence (I to VII) | Key outcomes, recommendations or findings |
| Al-Toma A, V. U. (2019 ). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 7(5):583-613. | I | The coeliac disease guideline and other disorders related to gluten. |
| Rubio-Tapia A, M. J. (2019). Updated guidelines by the European Society for the Study of Coeliac Disease [editorial]. United European Gastroenterol J. 7(5):581-2. | II | Guidelines according to the Society or Europe concerning the Study of the Coeliac Disease. |
| Alberto Rubio-Tapia, J. A. (2019, June 1). Updated guidelines by the European Society for the Study of Coeliac Disease. | III | Guidelines according to the Society of Europe concerning the Coeliac Disease Study Updated. |
| Abdulbaqi Al-Toma, U. V. (2019, April 13). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. | IV | Society of Europe involving the of Coeliac Disease Study guideline and diseases related to gluten. |
| Rachael Link, M. R. (2016, December 6). 9 Signs and Symptoms of Celiac Disease. | V | Nine Celiac Disease Symptoms and Signs. |
References
Collin, P. S. (2017). Dermatitis herpetiformis: a cutaneous manifestation of coeliac disease. Annals of medicine. 49(1), 23-31.
Crocker, H. J. (2018). Quality of life in coeliac disease: item reduction, scale development, and psychometric evaluation of the Coeliac Disease Assessment Questionnaire (CDAQ). Alimentary pharmacology & therapeutic. 48(8), 852-8.
Curtis, K. F. (2017). Translating research findings to clinical nursing practice. Journal of clinical nursing. 26(5-6), 862-872.
Esteve, M. R. (2018). Case-finding in primary care for coeliac disease: accuracy and cost-effectiveness of a rapid point-of-care test. United European gastroenterology journal. 6(6), 855-865.
Lebwohl, B. S. (2018). Coeliac disease. The Lancet. 391(10115), 70-81.
Leffler, D. A. (2015). Extra-intestinal manifestations of coeliac disease. Nature Reviews Gastroenterology & Hepatology. 12(10), 561.
Lindfors, K. C. (2019). Coeliac disease. Nature Reviews Disease Primers. 5(1), 1-18.
White, S. S. (2015). Perioperative nursing leaders implement clinical practice guidelines using the Iowa Model of Evidence-Based Practice. AORN journal. 102(1), 50-59.
