Celiac Disease
Definition
Celiac disease (CD) is also referred to as a gluten sensitive enteropathy (GSE), gluten intolerance, or celiac sprue. It is considered to be the most under-diagnosed common disease today, affecting 1 in every 133 people in the USA. It is a chronic, inherited disease, and if untreated can ultimately lead to malnutrition. Gluten intolerance is the result of an immune-mediated response to the ingestion of gluten (from wheat, rye, and barley) that damages the small intestine. Nutrients then quickly pass through the small intestine, and will not be adequatly absorbed.
Symptoms
Celiac disease affects people differently. Symptoms may occur in the digestive system, or in other parts of the body.
Symptoms of celiac disease may include one or more of the following:
- recurring abdominal bloating and pain
- chronic diarrhea
- constipation
- pale, foul-smelling, or fatty stool
- weight loss/weight gain
- fatigue
- unexplained anemia (a low count of red blood cells causing fatigue)
- bone or joint pain
- osteoporosis, osteopenia
- behavioral changes
- tingling numbness in the legs (from nerve damage)
- muscle cramps
- seizures
- missed menstrual periods
- infertility, recurrent miscarriage
- delayed growth
- pale sores inside the mouth, called aphthous ulcers
- tooth discoloration or loss of enamel
- itchy skin rash called dermatitis herpetiformis
A person with celiac disease may have no symptoms. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anemia, delayed growth, and weight loss are signs of malnutrition: The body is just not getting enough nutrients. Malnutrition is a serious problem for children because they need adequate nutrition to develop properly.
Diagnosis of celiac disease
Diagnosing celiac disease can be difficult because some of its symptoms are similar to those of other diseases, including irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticulosis, intestinal infections, chronic fatigue syndrome, and depression.
People with celiac disease have higher than normal levels of certain antibodies in their blood. Antibodies are produced by the immune system in response to substances that the body perceives to be threatening. To diagnose celiac disease, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium, and anti tissue transglutaminase.
If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. This is done in a procedure called a biopsy: the physician passes a long, thin tube called an endoscope through the mouth and stomach into the small intestine, and then takes a sample of tissue using instruments passed through the endoscope. Biopsy of the small intestine is the best way to diagnose celiac.
Treatment
- Patients must eliminate all sources of Gluten even small trace amounts. Once the gluten free diet is maintained, the intestine may heal and overall health will improve.
- Lifestyle changes will be required in order to adapt to the gluten free diet. Left untreated, Celiac Disease can be life threatening.
- Long term complications can include, Lymphoma, a cancer of the gastrointestinal track, Osteoporosis and severe nutritional deficiencies.
- People with Celiac Disease must be aware of hidden gluten in products which do not specifically list wheat, rye, barley or oats.
These products include soups, salad dressings, processed foods and pharmaceuticals.
Other sources of hidden gluten can be found on labels noting: starch, modified food starch, HVP (Hydrolyzed Vegetable Protein), HPP (Hydrolyzed Plant Protein), binders, fillers, extenders, malt, natural flavoring.