Celiac Disease


Fact: It is estimated to affect 1 in 100 people worldwide.

What is Celiac Disease?
Celiac disease is a serious genetic autoimmune disorder where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide.  However, most—85 percent or more—don't realize they have the condition and the average patient waits more than four years for an official diagnosis.

When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body. The only treatment currently for celiac disease is a strict, gluten-free diet. Most patients report symptom improvement within a few weeks, although intestinal healing may take several years.

Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.

Celiac disease is also known as coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.


Symptoms
There are more than 300 symptoms of celiac disease, and symptoms can be different from person to person.

The signs and symptoms of celiac disease can vary greatly and are different in children and adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.

However, more than half of adults with celiac disease have signs and symptoms that are not related to the digestive system, including:

  • Anemia, usually resulting from iron deficiency
  • Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
  • Itchy, blistery skin rash (dermatitis herpetiformis)
  • Damage to dental enamel
  • Mouth ulcers
  • Headaches and fatigue
  • Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
  • Joint pain
  • Reduced functioning of the spleen (hyposplenism)
  • Acid reflux and heartburn


Children
In children under 2 years old, typical signs and symptoms of celiac disease include:

  • Vomiting
  • Chronic diarrhea
  • Swollen belly
  • Failure to thrive
  • Poor appetite
  • Muscle wasting

Older children may experience:

  • Diarrhea
  • Constipation
  • Weight loss
  • Irritability
  • Short stature
  • Delayed puberty
  • Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures

Dermatitis herpetiformis
Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.

Dermatitis herpetiformis is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the disease may not produce noticeable digestive symptoms.
Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.


What Causes Celiac Disease?
Normally, the body's immune system is designed to protect it from foreign invaders. When people with celiac disease eat foods containing gluten, their immune system forms antibodies to gluten which then attack the intestinal lining. This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. Nutrients from food are normally absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients properly and ends up malnourished, no matter how much he or she eats.


Risk factors
Celiac disease can affect anyone. However, it tends to be more common in people who have:

  • A family member with celiac disease or dermatitis herpetiformis
  • Type 1 diabetes
  • Down syndrome or Turner syndrome
  • Autoimmune thyroid disease
  • Microscopic colitis (lymphocytic or collagenous colitis)
  • Addison's disease
  • Rheumatoid arthritis


Complications
Untreated, celiac disease can cause:

  • Malnutrition. The damage to your small intestine means it can't absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.
  • Loss of calcium and bone density. Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.
  • Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.
  • Lactose intolerance. Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don't contain gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose intolerance despite successful management of celiac disease.
  • Cancer. People with celiac disease who don't maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
  • Neurological problems. Some people with celiac disease may develop neurological problems such as seizures or peripheral neuropathy (disease of the nerves that lead to the hands and feet).


In children, celiac disease can also lead to failure to thrive, delayed puberty, weight loss, irritability and dental enamel defects, anemia, arthritis, and epilepsy.

Screening and Diagnosis
A simple blood test is available to screen for celiac disease. People with celiac disease who eat gluten have higher than normal levels of certain antibodies in their blood. These antibodies are produced by the immune system because it views gluten (the proteins found in wheat, rye and barley) as a threat.  You must be on a gluten-containing diet for antibody (blood) testing to be accurate.

The only way to confirm a celiac disease diagnosis is by undergoing an endoscopic biopsy of the small intestine.


How Is Celiac Disease Treated?
If you have celiac disease, you can't eat any foods that contain gluten (including wheat, rye, barley, and oats). Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. In most cases, the villi are healed within six months.
You'll have to remain on this diet for the rest of your life; eating any gluten at all can damage the intestine and restart the problem.

Some people with celiac disease have so much damage to their intestines that a gluten-free diet will not help them. These patients may have to receive nutritional supplements through an IV.


Living With a Gluten-Free Diet
A gluten-free diet will be a big change in your life. You have to rethink your eating habits, including what you buy for lunch, what you eat at parties, or what you snack on. Following a gluten-free diet means you cannot eat many dietary "staples," including pasta, cereals, and many processed foods that contain grains. You will need to be careful when eating packaged foods, as they may contain gluten.

Always read the ingredients of packaged foods and when eating in restaurants, ask about the ingredients of a dish before ordering.


But, just because you have celiac disease, it doesn't mean you can't enjoy a well-balanced diet. For instance, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available. Food companies and some grocery stores also carry gluten-free bread and products.

You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats and fish, since these do not contain gluten.


​Want to learn more?

The following are organizations and/or websites dedicated to providing information and education surrounding Celiac Disease. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

Beyond Celiac
Celiac Disease Foundation
Mayo Clinic
National Institute of Diabetes and Digestive and Kidney Diseases
Very Well
WebMD


Information on this page taken directly from:
Beyond Celiac
Celiac Disease Foundation
Mayo Clinic
Very Well
WebMD