The following cereals should be avoided in patients with celiac diseases, except:
Ans. is 'c' i.e. maizeRef.: Robbings 6th/e page 813, Chandrasoma Taylor 3rd/e 591The fundamental disorder in celiac sprue is sensitivity to gluten which is alcohol soluble, water-insoluble protein component. It is found in wheat and closely related grains such as oat, barley, and rye.Celiac disease presents with features of malabsorption and the characteristic is that withdrawal of gluten-containing substances from the diet i.e. (wheat, oat barley and rye) produces a dramatic improvement in the disease.More questions on celiac diseaseIn celiac disease, the proximal intestine is commonly involved while in tropical sprue whole of the intestine is involved.Biopsy of intestine in celiac sprue demonstrates.Villous atrophy, loss of microvilli brush borderThe crypts are hyperplastic and become elongated.Presence of following cells on lamina propriaPlasma cells Lymphocytes Macrophages Eosinophils Mast cellsRemember that overall mucosal thickness remains same in celiac sprueCeliac ds. is associated with dermatitis herpetiformis.Pathological features of celiac disease have always been asked.Celiac disease is caused by the action of acidic peptides containing the gliadin fraction of wheat.The basic abnormality is thought to be an increased rate of loss of epithelial cells. Crypt cells show increased activity. This causes hypertrophy of crypt. But even this increased activity cannot keep pace with the loss of cells, resulting in a progressive decrease in height of villi causing villous atrophyThe epithelial cells show decreased cytoplasm and mucusThe intestinal biopsy shows a decrease in the villus: crypt ratio. Normally the villi are 3-4 times the height of the crypts (ratio of 3-4: 1); in celiac disease, the ratio decreases progressively (partial, subtotal and total villous atrophy). Total villous atrophy is seen in severe celiac ds and is quite characteristic of celiac ds (partial villous atrophy may be seen in many other conditions).
Wheat
Barely
Maize
Rye