Celiac Disease

Celiac disease, also known as gluten-sensitive enteropathy, is an autoimmune disease in which eating gluten damages your small intestine. It is  a specific digestive disease that not only damages the small intestine, but also interferes with absorption of nutrients from foods. Celiac disease is genetic, and about 30 percent of people have it.

The most important characteristic of this condition is that people who have celiac disease cannot tolerate a protein which is called gluten. This protein can be found in grains like wheat, rye, and barley. This protein can also be found in products such as stamp and envelope adhesive, medicines, and vitamins. Celiac disease is considered an autoimmune disorder although some experts also classify it as a disease of malabsorption.

What else should you know about celiac disease? Let's take a look!

Mechanism of intestinal destruction

When people with celiac disease try to eat food that contains gluten in it, their immune system responds by damaging the small intestine. It means that the fingerlike protrusions lining the small intestine called villi are damaged or even destroyed when you eat gluten. Villi normally allow nutrients from food to be absorbed into the bloodstream. Without healthy villi however, a person becomes malnourished, regardless of the quantity of food eaten. Celiac disease is also known as celiac sprue, nontropical sprue, as well as gluten-sensitive enteropathy.

Possible causes of Celiac disease

The exact cause of celiac disease is still unknown, though we do know some things about celiac disease. However it is known that Celiac disease is a genetic disease, which means that it runs in families. If someone in your immediate family has celiac disease, chances are 10 to 20 percent that you may have it too. It is also known that sometimes the disease can be triggered after:

• surgery,
• pregnancy
• childbirth
• viral infection
• severe emotional stress

Other risk factors for developing this condition may include:

• Lupus erythematosus
• Type 1 diabetes
• Rheumatoid arthritis
• Autoimmune thyroid disease

Incidence

Celiac disease may be much more common in the United States than previously believed.
One study conducted on more than 13,000 people, found that one in 133 participants had the disease.  The number of patients is rising because the previous under diagnosis of celiac disease may be because the disorder resembles several other conditions that can cause malabsorption.
 

What are the symptoms of celiac disease?

Celiac disease affects people differently. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Some people with celiac disease have no symptoms at all. Symptoms of celiac disease may include one or more of the following:

• gas
• recurring abdominal bloating and pain
• chronic diarrhea
• pale, foul-smelling, or fatty stool
• weight loss / weight gain
• fatigue
• unexplained anemia
• bone or joint pain
• osteoporosis, osteopenia
• behavioral changes
• tingling numbness in the legs  
• muscle cramps
• seizures
• missed menstrual periods – amenorrhea
• infertility, recurrent miscarriage
• delayed growth
• failure to thrive in infants
• pale sores inside the mouth
• tooth discoloration or loss of enamel
• itchy skin rash called dermatitis herpetiformis
• sings of malnutrition such as anemia, delayed growth, and weight loss

Diagnosis of Celiac disease

This condition because is frequently misdiagnosed or overlooked as it can be similar to many other conditions. It is most frequently confused with:

• diarrhea
• persistent indigestion
• a rash
• irritable bowel syndrome

There are several tests that can be used to assist the diagnosis. 

Blood tests

The first tests to be done are usually blood tests. A blood test can detect high levels of antibodies and is used to initially detect those who are most likely to have the disease and who may need further testing. It is also important to know that it is possible for a person to have negative results, and still have celiac disease. In those cases the next step in diagnosis is a biopsy. 

Endoscopy with biopsy

The most accurate diagnostic tool is definitely an upper endoscopy with biopsy of the distal duodenum or jejunum. It is important for the physician to obtain multiple samples from various places throughout the intestine. Sometimes even upper endoscopy carries a risk of false negative results. This is because celiac disease may or may not damage villi throughout the entire small intestine, and upper endoscopy only examines the upper part of the intestine. 

Trial diet

In the last couple of years, this diagnostic tool has become very popular. A trial of a gluten-free diet can also confirm a diagnosis. If the symptoms disappear, the results are clear.
 

Complications of celiac disease

Malnutrition
The biggest danger of untreated celiac disease is malabsorption which in turn can lead to malnutrition. This occurs in spite of what appears to be an adequate diet. Malabsorption can lead to a deficiency in vitamins A, B-12, D, E and K, and folate, resulting in anemia and weight loss. Malnutrition can cause stunted growth in children and delay their development.

Loss of calcium and bone density
The continued loss of fat in the stool may also cause an excessive loss in calcium and vitamin D. This could be very dangerous because it may result in a bone disorder called osteomalacia, a softening of the bone also known as rickets in children, and loss of bone density. It is also proven that lack of calcium absorption can lead to a certain type of kidney stone.

Lactose intolerance
If the intestine has already been damaged by the gluten consumption, foods that don't contain gluten also may cause abdominal pain and diarrhea. Great majority of people with celiac disease aren't able to tolerate milk sugar found in dairy products and this condition is called lactose intolerance. If this is the case, you need to limit food and beverages containing lactose as well as those containing gluten. Once your intestine has healed, you may be able to tolerate dairy products again. 

Cancer
People with celiac disease who don't maintain a gluten-free diet also have a greater chance of getting one of several forms of cancer. The most common forms are intestinal lymphoma and bowel cancer.

Neurological complications
Celiac disease has also been associated with disorders of the nervous system, including epilepsy and nerve damage although this is very rare.

Treatment of celiac disease

Unfortunately there is no cure for celiac disease but the patients can effectively manage their disease through dietary changes. Once gluten is removed from diet, inflammation in small intestine will begin to subside, usually within several weeks.
Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.
 

Gluten free diet

To manage the disease and prevent complications, it's crucial that all foods that contain gluten are being avoided. Foods rich in gluten are :

• Grains
• Wheat
• Barley
• Rye
• Any type of wheat (including farina, graham flour, semolina and durum
• Bulgur
• Kamut
• Kasha
• Matzo meal
• Spelt
• Triticale
• Breads, Cereals, Crackers, Pasta, Cookies, Cakes and pies, Gravies, Sauces

There is still a lot of food that is allowed in a gluten-free diet. These include:

• Fresh meats, fish and poultry (not breaded or marinated)
• Most dairy products
• Fruits
• Vegetables
• Rice
• Potatoes
• Gluten-free flours (rice, soy, corn, potato)

Gluten-free products abound

There is an increasing number of gluten-free products on the market. There are gluten-free substitutes for many gluten-containing foods, from brownies to beer. The only problem is that identifying gluten-free foods can sometimes be difficult.

What after ingestion of gluten?

If patient accidentally eats a product that contains gluten, he or she may experience abdominal pain and diarrhea. Some people experience no symptoms after eating gluten, but this doesn't mean it isn’t doing any harm. 

Most people with celiac disease who follow a gluten-free diet have a complete recovery.