Celiac disease is a lifelong autoimmune intestinal disorder, found in individuals who are genetically susceptible. Damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten and interferes with the absorption of nutrients. Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the trigger. Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with CD. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, rye, barley, and triticale and must be eliminated.

Cause

The cause of Celiac Disease, also known as celiac sprue, or gluten sensitive enteropathy (GSE), is unknown. Current research indicates that CD is strongly associated with a group of genes on Chromosome 6. These genes (HLA class II antigens) are involved in the regulation of the body’s immune response to the gluten protein fractions.

One out of 133 people in the United States is affected with celiac disease. CD occurs in 5-15% of the offspring and siblings of a person with celiac disease. In 70% of identical twin pairs, both twins have the disease. It is strongly suggested that family members be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25% increased risk of having celiac disease.

Symptoms

Celiac Disease may appear at any time in a person’s life. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often mimic other bowel disorders. Infants, toddlers, and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:

  • abdominal cramping, intestinal gas, distention and bloating
  • chronic diarrhea or constipation (or both)
  • steatorrhea — fatty stools
  • anemia – unexplained, due to folate, B12, B6, or iron deficiency (or all)
  • weight loss with large appetite, or weight gain

Other symptoms:

  • dental enamel defects
  • osteopenia, osteoporosis
  • bone or Joint pain
  • fatigue, weakness and lack of energy
  • infertility – male/female
  • depression
  • aphthous ulcers

Dermatitis Herpetiformis (DH) is skin manifestation of celiac disease characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have gastrointestinal damage without perceptible symptoms.

Diagnosis

A person seeking preliminary diagnosis must be consuming gluten. Specific antibody blood tests are used to identify the presence of CD and are the initial step in screening. Blood tests include: Anti-Gliadin (AGA) IgA, (AGA) IgG, Anti-Endomysial (EMA) IgA, Anti-tissue transglutaminase (tTG) and total serum IgA. It is essential that patients with positive antibody test, and those with an IgA deficiency, have a small bowel biopsy to confirm the diagnosis and assess the degree of mucosal damage.

When serology and biopsy are inconclusive, testing for specific HLA (human leukocyte antigen) genes associated with celiac disease may be helpful in screening for CD. If these genes are NOT present, it is unlikely that the individual will develop CD. A positive HLA or genetic test, however, does not mean that the individual has the condition, as these genes are common in the general population. Patients should consult with an experienced physician to ensure proper diagnosis.

Dermatitis Herpetiformis (DH) is the skin manifestation of celiac disease. It is diagnosed by a biopsy of a skin lesion and staining for IgA in the tissues. More than 85% of DH patients have small-bowel sensitivity to gluten. Everyone with DH needs to follow a gluten-free diet.

What Happens With Celiac Disease

When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food, are damaged. This is due to an immunological reaction to gluten. Damaged villi do not effectively absorb basic nutrients — proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts. If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders — both nutritional and immune related.

Some long-term conditions that can result from untreated CD:

  • Iron deficiency Anemia
  • Osteoporosis
  • Vitamin K deficiency associated with risk for hemorrhaging
  • Vitamin and mineral deficiencies
  • Central and peripheral nervous system disorders — usually due to unsuspected nutrient deficiencies
  • Pancreatic insufficiency
  • Intestinal Lymphomas and other GI malignancies
  • Lactose intolerance

Other associated autoimmune disorders:

  • Dermatitis Herpetiformis (DH)
  • Insulin-dependent Type I Diabetes Mellitus
  • Thyroid Disease
  • Systemic Lupus Erythematosus
  • Liver Diseases

Less commonly linked to CD:

  • Addison’s Disease
  • Chronic Active Hepatitis
  • Down Syndrome
  • Myasthenia Gravis
  • Rheumatoid Arthritis
  • Turner Syndrome
  • Williams Syndrome
  • Sjogren’s Syndrome

Treatment

The only treatment for CD/DH is the lifelong adherence to gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is normally not required. Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be measured at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Potential harmful ingredients include:

  • unidentified starch
  • modified food starch
  • hydrolyzed vegetable protein – HVP
  • hydrolyzed plant protein – HPP
  • texturized vegetable protein – TVP
  • binders
  • fillers
  • excipients
  • extenders
  • malt

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Source: Celiac Disease Foundation

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