Celiac Disease

(Also known as gluten-sensitive enteropathy, celiac sprue, and nontropical sprue)

In this disease, the immune system damages the absorptive lining of the small intestine. This inappropriate action of the immune system is triggered by exposure to gluten. Gluten is a protein that is found in wheat, rye, barley, and many processed foods, medications, and supplements. As a result of this damage, the small intestine cannot do its job absorbing food and nutrients, which can lead to symptoms.

Who gets it?

This can happen in people of any age, in both men and women. It is more common in people whose families are from northern Europe.

Why does it happen?

The cause of this disorder is unclear. It is likely due to a combination of environmental and genetic factors. 70% of people with celiac disease will feel better within 2 weeks after stopping gluten consumption.

What are the symptoms?

The symptoms are variable. Sometimes, people with celiac disease will have no symptoms at all. Even if you do not have symptoms, it is possible to not be absorbing nutrients properly. Possible symptoms include:

Diarrhea
Weight loss
Abdominal discomfort
Excessive gas
Problems due to nutrition deficiencies such as:
Weakening of the bones (osteopenia or osteoporosis)
Low blood count because of decreased iron absorption (iron deficiency anemia)

Some conditions are more common in people with celiac disease:

Thyroid problems
Dermatitis herpetiformis- a very itchy rash with raised fluid-filled areas on the skin.
Diabetes mellitus
Disorders of the nervous system such as depression, epilepsy, migraines
Liver problems

How is it diagnosed?

Testing must be performed when a patient is on a gluten-RICH diet because if gluten is removed, the immune system is not activated to attack. Without the immune response, the small intestine tissue can heal and look completely normal.

Blood tests. Antibodies and proteins made by the immune system to attack gluten can be measured.
Biopsy of the small intestine. A biopsy is a small tissue sample that can be obtained at the time of an upper endoscopy. There are characteristic changes in a person who has celiac disease.
Genetic testing. With this test, a patient can be on a gluten-free diet because the results are constant and not impacted by what you eat.

There are several different presentations of Celiac disease that can be separated into groups:

Classical: the small intestine shows signs of damage and nutrients are not absorbed well
Atypical: there is evidence of damage to the small intestine but very mild symptoms such as iron deficiency, bone loss (osteoporosis), or infertility. This is actually the most common form.
Latent: Blood tests are positive for celiac disease but the small intestine looks normal under the microscope. In general, these people are not told to eat a gluten-free diet. If symptoms develop, a biopsy should be repeated.
Silent: Blood tests and biopsy of the small bowel show findings consistent with celiac disease but there are no other symptoms. You should be tested for malabsorption of specific nutrients.

How is it treated?

There is no cure. Avoiding foods or products with gluten will stop the immune response and the damage to the small intestine. This diet can be a challenge and requires major lifestyle adjustments. The diet is very effective. Strict avoidance of gluten is necessary because even small amounts of exposure to gluten can aggravate the disease.

It is helpful to have a dietician’s help to learn:

How to eat gluten-free and what foods to avoid
How to eat a balanced diet
How to shop gluten-free and prepare food

Typically, you will be tested for specific nutrients that are sometimes deficient; if values are low, you may be on a supplement for a while.

What are the complications?

Refractory disease. In a small number of people, symptoms do not improve despite a strict gluten-free diet, or, there is an improvement at first and then the symptoms return. It is not known why this happens but sometimes the immune system needs to be suppressed with steroids.
Ulcerative jejunitis. The second part of the small intestine, the jejunum, can form ulcerations that do not heal, leading to a lack of appetite, weight loss, abdominal pain, diarrhea, and fever. This can be suspected in patients with refractory celiac disease who do not improve with steroids. Surgery may be necessary to remove the ulcerated area.
Lymphoma. Cancer of the intestinal lymph system can develop; this is uncommon.

What can I do?

If you have celiac disease the most important thing you can do is maintain a gluten-free diet. When you are first diagnosed you may not tolerate dairy products until the damage to your intestines has time to heal.