Celiac Disease

By:    Medically Reviewed: Tom Iarocci, MD   Published: July 31, 2013

Celiac disease is a common autoimmune disorder that can occur at any age.

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Celiac disease is a common autoimmune disorder that can occur at any age. Unlike gluten, celiac disease can cause damage to the lining of the small intestine when gluten is consumed.

The prevalence of celiac disease in the United States is about one percent, and rising. But because symptoms can vary, it is difficult to diagnose in all patients early.

Among adults, women are more often diagnosed than men. Symptoms may include abdominal pain/discomfort and diarrhea, but celiac disease can also begin more silently, without diarrhea, in association with iron-deficiency anemia or osteoporosis, for example.

There is no cure for celiac disease, but the symptoms can be effectively managed by following a gluten-free diet. There is increased risk of complications in patients who are not treated, including intestinal malignancy and severe malabsorption.

Symptoms

In adults, symptoms of celiac disease can vary dramatically from one person to another, and gastrointestinal symptoms may be absent. For example, one person with celiac disease may be asymptomatic; another may suffer from chronic diarrhea with abdominal pain and discomfort; others may have more general symptoms such as fatigue.

Diarrhea is often thought of as a classic symptom, but this is the main symptom in only about 50% of adults according to a recent study. More silent presentations include iron-deficiency anemia, osteoporosis, and accidental discovery during testing for other conditions. Less commonly adults may have abdominal pain, constipation, weight loss, neurologic symptoms (seizures, numbness or tingling), or dermatitis herpetiformis (itchy skin rash). Chronic and sustained damage to the intestines caused by celiac disease can result in the malabsorption of nutrients and related complications.

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, and malabsorption. Left untreated, in infants and children malabsorption may result in failure to thrive, delayed growth and short stature, delayed onset of puberty, and 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

A definitive diagnosis should be made before following a lifelong gluten-free diet. 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 tiny villi in the small intestine that help you absorb nutrients. A doctor will utilize an endoscope, a long, thin tube in order to perform the biopsy.

Treatment

Therapy for celiac disease is a gluten-free diet, but it can be hard to keep gluten out of your diet completely, and many patients have persistence or recurrence of symptoms. Certain foods should be eliminated completely from your diet.

Grains to avoid:

  • Wheat (including spelt, kamut, semolina, and triticale)
  • Rye
  • Barley (including malt)
  • Bulgur
  • Durum
  • Farina
  • Graham flour 

Safe grains:

  • Rice, amaranth, buckwheat, corn, millet, quinoa, sorghum, tef (an Ethiopian cereal)

Starches and alternatives to wheat flour:

  • Arrowroot, jicama, taro, potato, tapioca
  • Chickpeas, lentils, kidney beans, navy beans, peanuts, soybeans
  • Almonds, walnuts, chestnuts, hazelnuts, cashews
  • Sunflower seeds, flax seeds, pumpkin seeds

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

Although there is currently no cure for celiac disease, there are many reasons for optimism. Today there are more gluten-free options at the supermarket than ever before, and public awareness of this condition has soared in the last decade. Research has progressed as well.

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