Celiac Disease

Celiac disease (also known as celiac sprue or gluten-sensitive enteropathy) is a digestive and multisystem disorder. Multisystem means that it may affect several organs. Celiac disease is a complex immune-mediated disorder, one in which the immune system causes damage to the small bowel when affected people eat gluten

Causes #

• Normally, the body’s immune system is designed to protect it from foreign invaders.

• When people with celiac disease eat foods that contain gluten, their immune systems attack the lining of the intestine.

• This causes inflammation (swelling) in the intestines and damages the villi, the hair-like structures on the lining of the small intestine.

• Nutrients from food are absorbed by the villi.

• If the villi are damaged, the person cannot absorb nutrients and ends up malnourished, no matter how much he or she eats.

Symptoms #

Symptoms of celiac disease vary among sufferers and include:

No symptoms at all (like some family members of celiac patients).

• Digestive problems (abdominal bloating, pain, gas, constipation, diarrhea, pale stools and weight loss).

• A severe blistering skin rash called dermatitis herpetiformis and sores in the mouth (called aphthous ulcers).

• Unexplained anemia (low blood count) or hepatitis (inflammation of the liver).

• Musculoskeletal problems (muscle cramps, joint and bone pain) and defects in dental enamel.

• Growth problems and failure to thrive (in children). This is because they cannot absorb the nutrients.

• Tingling sensation in the legs (caused by nerve damage and low calcium).

• Depression.

Diagnosis #

• If your healthcare provider thinks you might have celiac disease, they will perform a careful physical examination and discuss your medical history with you.

• The provider may also perform a blood test to measure levels of antibodies to gluten. People with celiac disease have higher levels of certain antibodies in their blood.

• Sometimes having a genetic test for celiac disease in the blood may be necessary.

• Your provider may perform other tests to look for nutritional shortages, such as a blood test to detect iron levels. A low level of iron (which can cause anemia) can occur with celiac disease.

• Your provider may take a biopsy from your small intestine to check for damage to the villi.

• In a biopsy, the doctor inserts an endoscope (a thin, hollow tube) through your mouth and into the small intestine and takes a sample of the small intestine with an instrument.

• This is done with sedation or anesthesia to avoid any discomfort during the procedure.

Risk factors #

Celiac disease can leave the patient vulnerable to other health problems, including:

• Malnutrition.

• Osteoporosis, a disease that weakens bones and leads to fractures. This occurs because the person has trouble absorbing enough calcium and vitamin D.

• Infertility.

• Cancer of the intestine (very rare).

People who have celiac disease may have other autoimmune diseases, including:

• Thyroid disease or liver disease.

• Type 1 diabetes.

• Lupus.

• Rheumatoid arthritis.

• Sjogren’s syndrome (a disorder that causes insufficient moisture production by the glands).

• Autoimmune liver disorders.

Treatment #

• If you have celiac disease, you can’t eat any foods that contain gluten (including wheat, rye and barley).
• You will be encouraged to visit with a dietitian for formal diet instruction.
• Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. However, the villi usually require months to years to complete healing.
• It might take two to three years for the intestines to heal in an adult, compared to about six months for a child.

• You’ll need regular medical follow-up visits (usually at 3 months, 6 months, and then every year) and have to remain on this diet for the rest of your life.

• Eating even a small amount of gluten can damage your intestine and restart the problem.

• Following a gluten-free diet means you cannot eat many staples, including pasta, cereals and many processed foods that contain gluten.

• There may also be gluten in ingredients added to food to improve texture or flavor and in some medicines.

• Some less obvious sources of gluten may include ice cream and salad dressing.

• Cross-contamination is another common source of gluten which happens when gluten-free foods come accidentally into contact with gluten.

• If you have celiac disease, you can still eat a well-balanced diet.

• For instance, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available.

• Food companies and some grocery stores also carry gluten-free bread and products.

• You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats and fish, since these do not contain gluten.

Prevention #

• Celiac disease cannot be prevented. However, early detection and management of celiac disease may prevent severe complications.

• Therefore, it is very important to check for celiac disease in persons at higher risk for having the condition, such as first-degree family members of patients with celiac disease.