All about celiac disease
It involves inflammation and destruction of the inner lining of the small intestine and can lead to the malabsorption of minerals and nutrients.
Celiac disease affects about 1 in 141 Americans. It can affect a person of any age who is genetically predisposed, but it often begins in middle infancy.
There is no cure, and the only effective treatment is a gluten-free diet.
Here are some key points about celiac disease. More detail is in the main article.
- Celiac disease is an autoimmune disorder that causes people to become intolerant to gluten.
- Long-term effects include anemia and malnutrition.
- The only effective treatment is a gluten-free diet.
- A gluten-free diet is only recommended for people who have a gluten allergy or intolerance.
People with celiac disease must avoid bread and other foods that contain gluten.
Celiac disease is a permanent disorder. Symptoms can range from mild to severe, they can change over time, and they can vary between individuals. Some people may have no symptoms, or symptoms may not appear until later in life.
Some common symptoms of celiac disease include:
- gastrointestinal symptoms, such as abdominal cramps, diarrhea, gas, nausea and vomiting, and bloating
- foul-smelling stools with excess fat in them
- bone and joint pain
- depression, irritability, and panic attacks
- weakness and fatigue
- easy bruising and nose bleeds
- fluid retention
- persistent hunger
- iron deficiency anemia
- malnutrition and nutrition deficiencies, including a lack of vitamin B12, D, and K
- mouth sores and tooth discoloration
- muscle wasting, muscle weakness, and muscle cramps
- nerve damage, leading to tingling in the legs and feet
- blood in the stools or in the urine
- migraine headaches
Some people develop a type of skin rash known as dermatitis herpetiformis (DH). Red, raised patches, and blistering may affect the elbows, knees, shoulders, buttocks, and face.
Celiac disease can lead to malabsorption and malnutrition, damage to the large intestine, and subtle damage to other organs.
Many adults with mild symptoms experience fatigue and anemia, or possibly only vague abdominal discomfort, such as bloating, abdominal distention, and excess gas. Some people have no clear signs of disease, but a general feeling of being unwell.
Variations in symptoms may may depend on:
- the length of time a person was breastfed, as symptoms tend to appear later in those who were breastfed for longer
- the amount of gluten consumed
- the age at which a person starts eating gluten
- the level of damage to the small intestine
Symptoms in infants and children
In children and infants, there may be intestinal problems, such as diarrhea, irritability, and a failure to thrive, or delayed development.
In time, children may experience weight loss, damage to tooth enamel, and delayed puberty.
The doctor will examine the patient and ask about signs and symptoms, and they may request some tests.
Blood tests may detect:
- antigliadin antibodies
- endomysial antibodies
- anti-tissue transglutaminase antibodies
Blood is screened for antibodies against deamidated gliadin peptide (TTG) and sometimes antigliadin (AGA) and andomysium antibodies (EmA).
A small intestinal biopsy is considered the most accurate test for celiac disease. The doctor uses endoscopy to take samples of the intestinal lining. Usually, several samples are obtained to increase the accuracy of the diagnosis.
Conditions that have similar symptoms to celiac disease include:
- pancreatic insufficiency
- Crohn's disease of the small intestine
- irritable bowel syndrome
- small intestinal overgrowth of bacteria
- gluten sensitivity, which has similar, but milder symptoms and is being debated as an entity
The doctor should eliminate these possibilities when making a diagnosis.
Currently, the only treatment is to avoid gluten for life.
With strict observance of the diet, the intestines will normally heal and symptoms disappear, but eating gluten again can cause a relapse.
Patients need to be aware which foods contain gluten and which do not, but this may be difficult, as many products contain hidden gluten.
A qualified dietitian can help a person with celiac disease follow a healthy diet.
Products with and without gluten
A wide range of products are available labelled gluten-free. These include gluten-free breads, pasta, cookies and so on. Manufacturers are required to provide information about the ingredients used to make their food products, but individuals must check the label carefully before buying or consuming any product.
Gluten-free alternatives to bread, flour, pasta, and other foods are now widely available.
"Gluten-free" normally indicates that there is a harmless level of gluten rather than a total absence of it.
Regulations about the use of labelling on gluten-free products vary between countries, so patients should use caution.
A person who is following a gluten-free diet should avoid:
- all foods made from wheat, rye, bran, enriched flour, bulgur and barley, including cereals, breads, pasta, croutons, crackers, cakes, and cookies
- beer and other grain-based alcohol
Some oat preparations can be contaminated with wheat. In some cases, small quantities of oats are allowed into the diet under medical supervision.
Care should be taken with some food products that are produced in facilities that manufacture products containing gluten.
Many processed foods contain gluten, including:
- canned soups
- salad dressings, ketchup, and mustard
- soy sauce
- ice cream and candy bars
- processed and canned meats and sausages
Gluten may also be used in:
- some prescription and over-the-counter (OTC) medications
- vitamin products
- cosmetic products such as lipstick, lip gloss, chapstick, and toothpaste
- postage stamps
People with celiac disease often have a lactose intolerance, so avoiding lactose may help.
Anyone with celiac disease should read food labels carefully and check which restaurant foods are gluten-free. Some restaurants have a gluten-free menu.
A gluten-free diet for all?
Those who do not have celiac disease or a diagnosed gluten intolerance should speak to their doctor if they are thinking of "going gluten free."
A gluten-free diet can lead to other deficiencies, if not followed with care.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), "No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health."
Foods that are safe to consume
Cereals such as corn, millet, sorghum, teff, rice, and wild rice are safe to consume.
A person with celiac disease may need to take vitamin and mineral supplements to reduce the risk of deficiencies caused by the disorder.
Recipes can be made gluten free by substituting ingredients and adjusting the time and temperature used for baking.
Scientists are investigating medications that work directly in the intestines, treatments that affect the immune system, and vaccinations to treat celiac disease.
However, there is currently no treatment, except for avoiding gluten.
If the individual continues to consume gluten, this can affect their quality of life, and it may increase the risk of some medical conditions.
In rare cases, refractory disease may occur, if action is not taken to manage celiac disease. This most commonly happens because it is difficult to maintain a fully gluten-free diet.
In people with refractory disease, the condition has been present for so long that the intestines are no longer able to heal on diet alone, and a gluten-free diet will not help.
Medications, such as corticosteroids and immuno-suppressive drugs, may be prescribed.
Children with celiac disease
Left untreated, childhood celiac disease can result in small height in adulthood, but a child with celiac disease who switches to a gluten-free diet often starts to grow in height and recover any delay caused by the disorder. Intestinal damage begins to heal within weeks of removing gluten from the diet.
As time goes by, children may experience spontaneous remissions and remain free of the signs and symptoms of celiac disease until later in life, but symptoms can later reappear.
Celiac disease is an immune disorder. When a person with celiac disease eats gluten, their cells and immune systems are activated and attack and damage the small intestine.
In celiac disease, the immune system mistakenly attacks the villi in the small intestine. These become inflamed and impacted, and they may disappear. The small intestine is no longer able to absorb nutrients effectively. This can lead to a number of health risks and complications.
People who are more likely to have celiac disease include those with:
- another autoimmune disease, such as type 1 diabetes, rheumatoid arthritis, or an autoimmune disease that affects the thyroid or the liver
- a genetic disorder, such as Down syndrome or Turner syndrome
- a family member who has the disease
Having a family member with celiac disease increases a person's chance of having it to 1 in 10.