Celiac disease (British: Coeliac disease) is a disorder resulting from an immune reaction to gluten. It can affect, genetically, predisposed people of all ages, but often begins in middle infancy. Symptoms include chronic diarrhea, weight loss and fatigue, but in some cases the disorder can be asymptomatic. Celiac disease is caused by a reaction to gliadin (a gluten protein found in wheat, barley, rye, and sometimes oats).
The inflammation and destruction of the inner lining of the small intestine in celiac disease is caused by an allergic reaction to gluten in the diet. This chronic digestive disorder leads to the malabsorption of minerals and nutrients.
There is no cure for celiac disease. The only effective treatment for this disorder is a gluten-free diet.
According to Medilexicon's medical dictionary, celiac disease is:
"a disease occurring in children and adults characterized by sensitivity to gluten, with chronic inflammation and atrophy of the mucosa of the upper small intestine; manifestations include diarrhea, malabsorption, steatorrhea, nutritional and vitamindeficiencies, and failure to thrive, or short stature."
What are the signs and symptoms of celiac disease?
A symptom is something the patient feels and describes, such as a stomachache, while a sign is detected by other people too, such as a rash.
Signs and symptoms of celiac disease may range from severe to mild. It is also possible to have celiac disease without any symptoms at all. Many adults with subtle disease only have fatigue and anemia, or may have only vague abdominal discomfort such as bloating, abdominal distension and excess gas.
Celiac disease is a permanent disorder and its effects may change from time to time during a person´s lifetime. Subtle symptoms can occur in other organs - other than the bowel itself.
Some signs and symptoms are due to malabsorption and malnutrition resulting from the disorder. It should also be noted that symptoms can vary greatly from person to person. Signs and symptoms associated with celiac disease can include:
- Abdominal cramps, gas and bloating
- Bone and joint pain
- Easy bruising
- Failure to thrive in children
- Flatulence (gas)
- Fluid retention
- Foul-smelling stools
- Gastritis, gastrointestinal symptoms, including hemorrhage
- General weakness, fatigue
- Increased amount of fat in the stools
- Persistent hunger
- Iron deficiency anemia
- Mouth Sores
- Muscle wasting, muscle weakness, muscle cramps
- Nausea, vomiting
- Nerve damage (tingling in the legs and feet)
- Nose bleeding
- Nutrient Deficiencies
- Panic Attacks
- Red urine
- Skin Rash
- Stomach Discomfort, stomach rumbling
- Unhealthy pale appearance
- Vitamin B12, D, and K deficiencies
- Weight Loss
- A degree of lactose intolerance may develop
- Dermatitis herpetiformis (rashes typically on the elbows, knees and buttocks)
- Sometimes symptoms are not clear, and the patient just generally feels unwell
How is celiac disease diagnosed?
Other diseases can produce the same signs and symptoms and can be confused with celiac disease (pancreatic insufficiency, Crohn's disease of the small intestine, irritable bowel syndrome, and small intestinal overgrowth of bacteria).
Blood tests: Blood tests that are specific for celiac disease include antigliadin antibodies, endomysial antibodies, and anti-tissue transglutaminase antibodies. Blood is screened for AGA (Antigliadin) and EmA (Andomysium Antibodies).
Small intestinal biopsy: This procedure is considered the most accurate test for celiac disease. During the endoscopy samples of the intestinal lining are taken. Usually several samples are obtained to increase the accuracy of the diagnosis.
What are the treatment options for celiac disease?
The standard treatment is a complete avoidance of gluten for life. Patients with the disease should avoid all products that contain gluten for the rest of their life. This is the only actual treatment. Strict observance to the diet allows the intestines to heal. This leads to the end of all symptoms in most cases.
It may be difficult avoiding gluten. Many products have hidden gluten in them. Generally, the advice of a dietitian is requested. It is essential for patients to educate themselves. Patients should be aware which foods contain gluten and which foods are safe. They should learn how to have a balanced diet despite the restrictions.
Failure to observe the diet may cause relapse. There are a variety of products on the market labeled gluten-free. The term gluten-free is generally used to indicate there is a harmless level of gluten rather than a total absence of it. Regulation of the label gluten-free varies widely by country, so patients should use caution. The general guidelines of a gluten free diet include:
- Avoid all foods made from wheat, rye, bran, enriched flour, bulgur and barley (cereals, breads, pasta, croutons, crackers, cakes, cookies..)
- Avoid beer and other grain-based alcohol.
- Avoid oats. Some oat preparations can be contaminated with wheat. In some cases small quantities of oats are allowed into the diet under medical supervision. Also some food products can be produced in facilities that manufacture gluten.
- Use caution with processed foods that may contain gluten (canned soups, salad dressings, soy sauce, seasonings, ice cream, candy bars, instant coffee, ketchup, mustard, processed and canned meats, sausages...)
- Read the food and product labels before buying or consuming any product. Manufacturers are required to provide information about the ingredients used to make their food products. Gluten containing fillers can be found in some prescription and over-the-counter medications. Gluten also can be found in many vitamin products, tablets, vitamin preparations and even cosmetic products such as lipstick, lip gloss, chapstick and toothpaste.
- Avoid milk and other dairy products that contain lactose. Untreated individuals with celiac disease often are lactose intolerant. With successful treatment, dairy products can be reintroduced slowly into the diet.
- Other cereals such as corn, millt, sorghum, teff, rice, and wild rice are safe for patients to consume. Non cereals such as amaranth, quinoa or buckwheat are also harmless.
- Non-cereal carbohydrate-rich foods such as potatoes and bananas, tapioca, garbanzo beans are safe to consume. They do not contain gluten and do not trigger symptoms.
It is recommended to take vitamin and mineral supplement to alleviate deficiencies caused by the disorder. Also, strict gluten restrictions can also lead to nutritional deficiencies. Many of the gluten-free foods are not fortified or enriched with vitamins or minerals.
Recipes can be converted into gluten-free recipes by substituting ingredients and adjusting time and temperature used for baking.
Refractory disease - in rare cases, patients suffer from refractory disease. These patients do not improve on a gluten-free diet. In some cases, the disease has been present for so long that the intestines are no longer able to heal on diet alone. Medications, such as corticosteroids and immuno-suppressive drugs may be prescribed.
Children with celiac disease - in children, switching to a gluten-free diet can lead to accelerated growth in height and recovering any delay caused by the disorder. Intestinal damage begins to heal within weeks of gluten being removed from the diet. If left untreated, childhood celiac disease can result in small height in adulthood. As time goes by, children may experience spontaneous remissions and remain free of the signs and symptoms of celiac disease until later in life. Symptoms can later reappear. Stress and anxiety have been known to bring on symptoms.
Consequences of untreated celiac disease
When left untreated, celiac disease considerably increases the risk of developing gastrointestinal cancer. The complications of celiac disease also include small bowel ulcers. Moreover, if this chronic digestive disorder is not properly treated, the patient's quality of life may be seriously undermined.
Celiac disease is fairly common in European countries and the United States. However, its prevalence is often underestimated, because many individuals who develop celiac disease have few or no symptoms until later in life.
There is more help available today for people with celiac disease. Information can be obtained from gluten-free product labels, websites, blogs, books, journals, cookbooks and associations.