What You Should Know about Celiac Disease
Celiac disease (CD) is one of the most common autoimmune illnesses in the United States. However, most people who have CD remain oblivious to their condition. As a result, they do not get the diagnosis and treatment they need to manage their health.
What Is Celiac Disease?
Celiac disease a genetic disorder that causes severe intolerance to a grain-based protein called gluten. Exposure to gluten from wheat, rye, barley, or food additives stimulates an aggressive immune response in the small intestine in sensitized individuals. This inflammation damages a type of specialized vascular tissue called “villi”. The villi are small, frond-like projections that grow from the mucous membrane lining the small intestine. They increase the surface area of the intestine, maximizing the amount of nutrition that can be absorbed into the bloodstream. When the villi are damaged, they cannot absorb nutrients effectively. Food malabsorption coupled with intestinal inflammation lead to the host of health problems experienced by celiac patients.
Who Is at Risk for Celiac Disease?
Only people with either the DQ2 or DQ8 gene are celiac sufferers. However, 25% to 40% of people in the general population have one of these genes. A much smaller percentage of the population (less than 5%) develops the autoimmune disorder. Theories about what triggers the disease vary. Studies about the impact of breastfeeding and early nutrition in the development of gluten intolerance have shown conflicting results. However, it is well-established that the risk for CD is much higher for people who have one or more family members with the disorder. Those with other autoimmune problems, Type 1 diabetes, or chromosomal abnormalities such as Down syndrome are also at higher than average risk.
Celiac Symptoms Checklist
Celiac disease can present in many different ways. Here are a few of the warning signs in children:
- Loose stool or diarrhea
- Foul smelling stool
- Abdominal bloating and pain
- Poor weight gain
- Learning difficulties
- Attention disorders
- Damaged teeth (eroded and discolored enamel)
Adult sufferers often have digestive problems (particularly diarrhea) and may also experience a range of other celiac disease symptoms:
- Dermatitis herpetiformis (skin blistering with a red, itchy rash)
- Canker sores inside the mouth
- Bone and joint pain
- Fatigue, depression, or anxiety
- Headaches and irritability
- Calcium deficiency (tingling in the extremities)
- Iron deficiency (anemia)
- Irregular menstrual cycles
- Infertility and repeated miscarriage
Symptoms may be chronic, or they may flare up with each exposure to gluten.
Tests to Confirm or Rule Out CD
Because some celiac testing procedures can be invasive or uncomfortable, genetic testing may be done first to make sure the patient is a carrier of one of the celiac genes. Blood testing can identify specific antibodies that the immune system creates to attack gluten. For these tests to be conclusive, patients must eat plenty of gluten in the months prior to the test to ensure the production of antibodies for analysis.
A tissue biopsy from the small intestine is often used to confirm the diagnosis and evaluate the damage to the villi. Intestinal samples are taken endoscopically through a long tube inserted into the throat, through the stomach, and into the intestine. A newer procedure called “capsule endoscopy” permits examination of the small intestine through a tiny camera that is swallowed in pill form. It captures hundreds of images of the intestinal wall and transmits these pictures wirelessly to a monitor for viewing.
What Is Celiac Disease Treatment Like?
Patients who are seriously ill from malnutrition may be treated with vitamin supplements or injections. Those with dermatitis herpetiformis or inflammation may receive medications to help reduce discomfort. Most patients are treated with dietary changes to completely eliminate the ingestion of gluten. They receive education from a dietitian on how to read and interpret product labels—since gluten can be hidden in many common foods as well as in supplements, pharmaceuticals, and cosmetics.
An entirely gluten free diet is the only successful method to get rid of symptoms and prevent them from recurring. It only takes a few weeks of gluten-free eating for most patients to notice a difference, although full recovery may take months or years. In many cases, when a patient is still symptomatic, it is because they are still ingesting trace amounts of gluten without realizing it. For patients who still don’t get better after going gluten-free, medicines that suppress the immune system may be the only option to reduce symptoms.
Long Term Health Effects and Related Disorders
Untreated celiac disease can lead to long-term health problems including:
- Early osteoporosis
- Iron deficiency anemia
- Liver disease
- Lactose intolerance
- Nervous system disorders, including seizures
- Pancreatic damage
- Gall bladder malfunction
- Intestinal cancer (rare)
Individuals with celiac disease are at higher risk for other autoimmune conditions as well. They may need to be monitored or tested for:
- Type 1 diabetes
- Autoimmune disorders of the thyroid or liver
- Addison’s disease (malfunction of the adrenal glands)
- Sjögren’s syndrome (damaged tear ducts and salivary glands)
- Rheumatoid arthritis
Quick Celiac Facts and Stats:
Celiac disease currently affects approximately 3 million Americans. Only about half a million know they have this disorder.
Not everyone with CD has symptoms—but the damage to the intestines is still occurring and leads to health problems later.
If a family member has CD, the risk of other family members having the same condition increases from 1 in 133 to 1 in 22.
Celiac disease tests are now available to differentiate between CD and diseases with similar symptoms. Tests can also show if an asymptomatic individual has CD or if they may be at risk.