ICMR issues guidelines for diagnosis & management of celiac disease in India

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The Indian Council of Medical Research (ICMR) issued guidelines for diagnosis and management of celiac disease, which is a chronic immune-mediated enteropathy caused in genetically susceptible individuals by ingestion of gluten proteins present in wheat, barley and rye.

There has been an increase in reporting of  celiac disease (CeD) in India, which may be due to increased recognition (due to newer diagnostic techniques) or increased incidence or both. Survey of the published literature indicates that there is a steady increase in the number of published papers dealing with CeD in India.

This could be due to an increase in interest in the disease amongst physicians, an increase in recognition of the disease, or due to true increase in the incidence of the disease. In the absence of previous baseline data on the incidence and prevalence of the disease, the latter possibility is difficult to prove. However, the opinion of the expert group was that in addition to increased recognition, there was likely to have been an increase in true prevalence of the disease in recent years. Similar phenomena have been reported from other countries, particularly in the Asia-Pacific region.

Earlier, the ICMR had created a Task Force on CeD in 2008, recognizing the need to focus on a disease that was beginning to be reported in sizeable sections of the population in several states of northern India. As recommended by the Task Force, data were collected on the prevalence of CeD in three regions of India through a population-based study carried out in three regions of the country.   

The Task Force also recommended that ICMR develop guidelines for the diagnosis and management of CeD in India. While several international groups have generated guidelines for the diagnosis and management of CeD, these were largely rooted in the experience of western countries. There has been considerable skepticism over the applicability of these guidelines in a country like India where tropical enteropathy or environmental enteropathy is so widely prevalent, and where the incidence of parasitic and other infections of the small intestine is significant.

Celiac disease was originally described as a disease causing chronic diarrhoea and malabsorption. Flattening of the villi, inflammatory cell infiltration in the mucosa and loss of surface area were the major reasons for the clinical manifestations. The understanding that this is an immune process in which the intestinal epithelium is damaged is now well accepted. Following from the original descriptions by Willem Karel Dicke relating wheat consumption to CeD, a large number of studies have now established the central role played by proteins from wheat, barley and rye. The disease occurs only in individuals with a certain genetic predisposition, but at the same time it does not necessarily occur in all such individuals.

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Source: 1, 2, 3

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