Celiac disease, also known as celiac sprue or gluten sensitive enteropathy, is an autoimmune disease affecting both children and adults. It is a chronic digestive disorder that results in adverse reactions to foods that contain gluten, a protein found in wheat, rye, and barley. Gluten can also be found in non-food products, such as lipstick and envelope glue. All sources of gluten must be avoided by patients with celiac disease.
In individuals with celiac disease, the villi, small finger-like extensions in the intestine, react to gluten by attacking themselves instead of absorbing nutrients as they are supposed to. This results in malabsorption of nutrients, especially calcium, fat, iron, and folate. For unknown reasons, the number of patients with celiac disease has increased fourfold in the past 60 years, creating a major health problem.
Causes of Celiac Disease
Celiac disease is genetic, most often occurring in patients who have some family history of the disease or of other autoimmune disorders. Apart from heredity, other risk factors for celiac disease include having:
- Type 1 diabetes
- Down syndrome
- Autoimmune thyroid disease
- Selective antibody deficiency
- Sjögren's syndrome
Symptoms are sometimes triggered by a major physical event such as pregnancy or childbirth, a viral infection, or an emotional trauma.
Symptoms of Celiac Disease
Patients with celiac disease may exhibit a wide range of symptoms that affect many different body systems. First and foremost, patients with celiac disease experience digestive symptoms, including:
- Abdominal bloating and gas
- Abdominal pain
- Light-colored, fatty, or foul-smelling stools
- Weight loss
In additions to these uncomfortable and sometimes debilitating symptoms, those with celiac disease may also suffer from a severe skin rash known as dermatitis herpetiformis, iron deficiency anemia, muscle cramps and joint pain, nerve damage and even seizures. Children with this disease may show symptoms of failure to thrive and women may experience missed menstrual periods.
Beyond this multitude of physical symptoms, patients with celiac disease may also suffer emotional symptoms, including irritability and depression and are at heightened risk of developing other autoimmune diseases, such as rheumatoid arthritis and lupus.
Diagnosis of Celiac Disease
In order to diagnose celiac disease, the doctor does a comprehensive medical examination and takes a full medical history. Blood tests are administered to check for abnormally high level of certain antibodies and for low levels of iron and other nutrients. In addition, the following tests may be administered:
- Abdominal CT scan
- Barium X-ray of the small intestine
- Enteroscopy of the small intestine
In addition, a stool sample is tested for the presence of fat in the stool because the disease prevents normal fat absorption. An endoscopic biopsy of tissue from the small intestine may also be taken to assess whether there has been damage to the villi lining its walls.
Treatment of Celiac Disease
The only treatment for celiac disease is maintaining a gluten-free diet and lifestyle. Removing gluten from the diet will eventually allow the small intestine to heal and prevent future damage. The gluten-free diet must be followed carefully to prevent symptom recurrence and maintain digestive health. Patients with celiac disease must refrain from ingesting any wheat, rye, and barley, as even a small amount can cause serious problems. Some patients may need to avoid oats as well, especially in the beginning. Once a gluten-free diet is followed, symptoms usually subside within a few days. Within 6 months on the diet the small intestine should heal.
In some cases, when there has been a delay in diagnosis of celiac disease and patients have already suffered irreparable intestinal damage, they may have to receive intravenous (IV) nutritional supplements.
Complications of Celiac Disease
There are many possible complications of uncontrolled celiac disease, including:
- Esophageal cancer
- Ulcerative jejunoileitis
- Reproductive issues, such as infertility
The best defense against possible complications of celiac disease is strict adherence to the gluten-free diet.