Celiac Disease

By Sonia GulatiΙ November 3, 2011

Celiac disease is an autoimmune disorder that damages the lining of the small intestine when gluten is consumed. Celiac disease afflicts 1 in 133 people in the United States. It can cause abdominal pain, diarrhea, and eventually diminish the ability to absorb nutrients from food. This malabsorption can cause long-term complications such as anemia, liver disease, and cancers of the intestine. Currently, there is no cure for celiac disease. However, the symptoms of celiac disease can be effectively managed by following a gluten-free diet.

Symptoms

The symptoms of celiac disease can vary dramatically from one person to another. For example, one person with celiac disease may be asymptomatic, another may suffer from chronic digestive distress, and others may experience more general symptoms such as fatigue. Adults are less likely to have digestive symptoms and may instead have one or more of the following:

Iron-deficiency anemia
Fatigue
Bone or joint pain
Arthritis
Osteoporosis
Depression or anxiety
Tingling or numbness in the hands and feet
Seizures
Missed menstrual periods
Infertility or recurrent miscarriage
Canker sores inside the mouth
Dermatitis herpetiformis (itchy skin rash)

Chronic and sustained damage to the intestines caused by celiac disease can result in the malabsorption of nutrients. Complications associated with malabsorption include:

Bruising easily
Depression or anxiety
Fatigue
Hair loss
Itchy skin
Mouth ulcers
Muscle cramps and joint pain
Nosebleeds
Short stature

Symptoms of celiac disease in infants and young children may include:

Abdominal bloating and pain
Chronic diarrhea
Vomiting
Constipation
Pale, foul-smelling, or fatty stool
Weight loss

Malabsorption of nutrients in infants and children may result in:

Failure to thrive
Delayed growth and short stature
Delayed onset of puberty
Dental enamel defects of the permanent teeth

Causes

The exact cause of celiac disease is unknown. However, it is known that both environmental and genetic factors contribute to the onset of celiac disease. In some cases, an initial flare up of celiac disease may be caused by pregnancy, childbirth, viral infection, or severe emotional stress. Celiac disease is genetic and therefore may be passed on from parents to their children. Physiologically, the consumption of gluten causes the body's immune system to overreact and damage the villi (hair-like projections that aid in the absorption of nutrients) of the small intestine. Without healthy villi, the body is unable to absorb nutrients necessary to sustain growth and overall health. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.

Diagnosis

In order to diagnose celiac disease, a doctor will initially perform a comprehensive physical exam and will ask about your symptoms and medical history. Your doctor may order additional tests and procedures including:

Blood Test. A blood test can detect if certain antibodies, such as anti-tissue transglutaminase or anti-endomysium antibodies are elevated. These antibodies are produced when people with celiac disease eat gluten. A blood test for these antibodies may also be prescribed for asymptomatic family members of person with celiac disease. This is because celiac disease is hereditary and four to twelve percent of an affected person's first-degree relatives will also have the disease.
Intestinal Biopsy. An intestinal biopsy can assess if there is damage to the villin in the small intestine. A doctor will utilize an endoscope, a long, thin tube in order to perform the biopsy.

Treatment

Celiac disease has no cure. However, it can be managed effectively by eating a gluten free diet. Some common foods that contain gluten are:

Barley
Bulgur
Durum
Farina
Graham flour
Rye
Semolina
Spelt (a form of wheat)
Triticale
Wheat

These foods should be eliminated completely from your diet. Within several weeks of removing gluten from the diet, inflammation in the small intestine will diminish. Symptoms associated with celiac disease may begin to subside as early as a few days after starting a gluten free diet. However, complete healing and regeneration of the villi may take up to two to three years to occur. In cases of severe inflammation in the small intestine, steroids may be prescribed. Steroids can provide relief from symptoms of celiac disease until the effects of a gluten-free diet become apparent.

If nutritional deficiencies associated with celiac disease are severe, vitamin and mineral supplements may be recommended by your doctor or dietitian to redress these deficiencies. Your doctor may recommend supplements to increase your levels of:

Calcium
Folate
Iron
Vitamin B-12
Vitamin D
Vitamin K

Vitamin supplements can be taken in pill form, however due to the damaged villi the digestive tract may not be able to absorb the vitamin and mineral supplements. In such situations, vitamins and minerals may be provided intravenously.