What is celiac disease?
Celiac disease damages the small intestine and interferes with absorption of nutrients from food. The disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. Because the body’s own immune system causes the damage, celiac disease is considered an autoimmune disorder. It is also classified as a disease of malabsorption, because nutrients are not absorbed efficiently. Celiac disease is a genetic disease. Sometimes the disease is triggered, or becomes active after severe emotional stress, surgery, pregnancy, childbirth, or viral infection.
People who suffer from celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Gluten occurs mainly in foods but may also be found in commonly used products such as envelope adhesive, medicines, and vitamins.
When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging the small intestine. Villi, which are tiny fingerlike protrusions lining the small intestine are damaged or destroyed. These structures normally permit nutrients from food to be absorbed into the bloodstream. Without healthy villi, the body becomes malnourished.
Recent findings estimate about 2 million people in the United States have celiac disease, or about 1 in 133 people. In Europe around 1 in 250 people have celiac disease. Recent studies have shown that it may be more common in Africa, South America, and Asia than previously thought.
What are the symptoms of celiac disease?
Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Indeed, irritability is one of the most common symptoms in children.
Symptoms of celiac disease may include one or more of the following:
• gas
• pale, foul-smelling, or fatty stool
• constipation
• recurring abdominal bloating and pain
• chronic diarrhea
• weight loss/weight gain
• fatigue
• unexplained anemia (a low count of red blood cells causing fatigue)
• bone or joint pain
• osteoporosis, osteopenia
• tingling numbness in the legs (from nerve damage)
• muscle cramps
• seizures
• missed menstrual periods (often because of excessive weight loss)
• infertility, recurrent miscarriage
• delayed growth
• failure to thrive in infants
• pale sores inside the mouth, called aphthous ulcers
• tooth discoloration or loss of enamel
• itchy skin rash called dermatitis herpetiformis
• behavioral changes
Some people with celiac disease may have no symptoms. Individuals without symptoms are still at risk of health problems associated with malnutrition. Anemia, delayed growth, and weight loss, for example, are caused malnutrition. Malnutrition is obviously a serious problem for children because they need adequate nutrition for optimal development.
The length of time a person is breastfed, the age a person started eating gluten-containing foods, and the amount of gluten-containing foods eaten are some of the factors thought to play a role in when and how the disease appears. Some studies have shown, for example, that the longer a person was breastfed, the later the symptoms of celiac disease appear and the more uncommon the symptoms.
Diagnosis of celiac disease.
Diagnosing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed.
People with celiac disease have higher than normal levels of certain autoantibodies in their blood. Antibodies are protective proteins produced by the immune system in response to substances that the body determines to be dangerous. Autoantibodies are proteins that react against the body’s own molecules or tissues.
If the tests and symptoms suggest celiac disease, the doctor will perform a small bowel biopsy to check for damage to the villi. To obtain the tissue sample, the doctor eases an endoscope through the mouth and stomach into the small intestine. Using instruments passed through the endoscope, the doctor then takes the sample.
Screening.
To diagnose celiac disease, doctors will usually test blood to measure levels of Immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA) and IgA anti-endomysium antibodies (AEA). Testing for celiac-related antibodies in children less than 5 years old may not be reliable. Up to 15 percent of an affected person’s immediate relatives will also have the disease. Around 8 percent of people with Type 1 diabetes will have celiac disease.
Before being evaluated, a patient should continue to eat a regular diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease, even if the disease is actually present.
What is the treatment?
The only treatment for celiac disease is to follow a gluten-free diet. When a patient is diagnosed with celiac disease, the doctor will refer them to a dietitian. A dietitian is a health care professional who specializes in food and nutrition. A dietician will advise the patient on how to read ingredient lists and identify foods that contain gluten in order to avoid gluten in food products and when eating out.
For most suffers, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Although improvements can be felt within days of starting the diet, the small intestine can take 3 to 6 months to fully heal in children and younger adults and up to 2 years for older adults. Eating any gluten, no matter how small an amount, can damage the small intestine. Some people with celiac disease show no improvement on the gluten-free diet. This condition is called unresponsive celiac disease. The most common reason for poor response is that small amounts of gluten are still present in the diet.
Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People in this situation have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. People with this condition may need to be evaluated for complications of the disease. Drug treatments are now being evaluated for unresponsive celiac disease.
Gluten-free Diet.
A gluten-free diet means not eating foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. In other words, a person with celiac disease should not eat most grain, pasta, cereal, and many processed foods. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers. Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods. Gluten is also used in the manufacture of some medications. Since gluten can also be used as an additive in unexpected products, it is important to read all labels. If the ingredients are not listed on the product label, the manufacturer of the product should provide the list upon request.
Meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Gluten-free products are becoming increasingly available.
Diseases Linked to Celiac Disease.
People with celiac disease tend to have other autoimmune diseases. The connection between celiac disease and these diseases may be genetic. These diseases include:
• thyroid disease
• systemic lupus erythematosus
• type 1 diabetes
• liver disease
• collagen vascular disease
• rheumatoid arthritis
• Sjögren’s syndrome
Research on Celiac Disease.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports research on celiac disease. NIDDK-researchers are studying the genetic and environmental causes of celiac disease. In addition, researchers are studying peptides in gluten that are believed to be responsible for the destruction of the immune system function. Enzymes are being engineered with the objective of destroying these immunotoxic peptides.
