Celiac disease (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Meagan E. Doherty

Overview

Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medications, vitamins, and lip balms. When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi (the tiny, finger-like protrusions lining the small intestine). Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food eats. Celiac disease is both a malabsorption disease (nutrients are not absorbed properly), and an abnormal immune reaction to gluten. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. Celiac disease is genetic, means it runs in families. Sometimes the disease is triggered (or becomes active for the first time) after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

What are the symptoms of celiac disease?

Symptoms of celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include:

• Abdominal bloating and pain
• Chronic diarrhea
• Vomiting
• Constipation
• Pale, foul-smelling, or fatty stool
• Weight loss
• Irritability is another common symptom in children.
• Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems, such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may have one or more of the following, instead:

• Unexplained iron-deficiency anemia
• Fatigue
• Bone or joint pain
• Arthritis
• Bone loss or osteoporosis
• Depression or anxiety
• Tingling or numbness in the hands and feet
• Seizures
• Missed menstrual periods
• Infertility or recurrent miscarriage
• Canker sores inside the mouth
• An itchy skin rash, called dermatitis herpetiformis

What causes celiac disease?

Celiac disease may be due to the following causes:

• Gluten allergy
• Inflammation of the bowel tissue
• Genetic mutations

Who is at highest risk?

People with celiac disease tend to have other diseases, in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may be genetic background. They include:

• Type 1 diabetes
• Autoimmune thyroid disease
• Autoimmune liver disease
• Rheumatoid arthritis
• Addison’s disease, a condition in which the glands that produce critical hormones are damaged
• Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed

Diagnosis

• Celiac disease can be hard to discover because its symptoms are like many other digestive diseases. People with celiac disease can go untreated for many years.
• People with celiac disease have higher than normal levels of certain autoantibodies (i.e., proteins that react against the body’s own cells or tissues) in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.
• Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease, even if the disease is present.
• If your test results show you might have celiac disease, the doctor will perform a biopsy to make sure celiac disease is the problem. For a biopsy, the doctor takes a small piece of tissue from your small intestine. To get to your small intestine, the doctor puts a long tube into your mouth and down into your stomach. At the end of the tube are small tools for snipping out the bit of tissue needed to view with a microscope. You will take medicine before the biopsy that makes you very sleepy. It also keeps you from feeling any pain. Many people sleep through the procedure.

Treatment options

• The only treatment for celiac disease is a gluten-free diet. Doctors may ask a newly diagnosed person to work with a dietitian on a gluten-free diet plan. A dietitian is a health care professional who specializes in food and nutrition. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.
• For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children, but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.
• To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.
• Some people with celiac disease show no improvement on the gluten-free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten are additives_, such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.
• Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. Researchers are evaluating drug treatments for refractory celiac disease.

The Gluten Free Diet

Allowed foods:amaranth, arrowroot, buckwheat, cassava, corn, flax, Indian rice grass, Job’s tears, legumes, millet, nuts, potatoes, quinoa, rice, sago, seeds, sorghum, soy, tapioca, teff, wild rice, yucca

Foods to avoid:wheat (including: einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein), barley, rye, triticale (a cross between wheat and rye)

Other wheat products:' bromated flour, durum flour, enriched flour, farina, graham flour, phosphated flour, plain flour, self-rising flour, semolina, white flour

Processed foods that may contain barley, wheat or rye:' bouillon cubes, brown rice syrup, candy, chips/potato chips, cold cuts, hot dogs, salami, sausage, communion wafers, French fries, gravy, imitation fish, matzo, rice mixes, sauces, seasoned tortilla chips, self-basting turkey, soups, soy sauce, vegetables in sauce

What to expect (Outlook/Prognosis)

Celiac disease is an incurable and chronic condition. Symptomatic onset may occur at any point during a patient's life and is a lifelong condition. Although incurable, celiac disease is manageable if the necessary precautions and dietary guidelines are followed. Strict adherence to a gluten-free diet is the only known way to treat Celiac disease.

How to prevent celiac disease

• Breastfeeding is the most effective proven measure to prevent celiac disease in infants. Delayed introduction of gluten-containing diet and decreasing its amount is also important.
• In cases established diagnosis of celiac disease, avoiding gluten-containing diet is the only method of preventing the development of the symptoms. Also vaccination against certain organisms is important if the spleen is affected.

Other Diseases with Similar Symptoms

• Food intolerance
• Colic
• Cystic fibrosis
• Crohn's disease
• Irritable bowel syndrome
• A parasitic infection of the intestine, such as giardiasis
• Some forms of colitis

Where to find medical care for Celiac Disease

Directions to Hospitals Treating Celiac Disease

What to expect (Outlook/Prognosis)?

• Prognosis of celiac disease is good with gluten free diet.
• Full recovery occurs within few months.

Possible complications

Complications that may develop include the following:

• B12 deficiency
• Iron deficiency
• Folate deficiency
• Anemia
• Hypoalbuminemia
• Osteoporosis
• Osteomalacia
• Increased risk of small bowel lymphoma

Sources

• http://www.csaceliacs.org/celiac_defined.php
• http://www.nlm.nih.gov/medlineplus/celiacdisease.html
• http://www.revolutionhealth.com/articles/other-conditions-with-symptoms-similar-to-celiac-disease/hw192139