What is It?
Celiac disease (CD) is triggered by the ingestion of gluten in genetically susceptible individuals. In those with CD, gluten containing foods (wheat, rye or barley) trigger an autoimmune reaction in which the body attacks its own tissues. As a result, the lining of the small intestine becomes damaged and the body’s absorption of nutrients is impaired. Thus, CD is considered both an autoimmune and a digestive disorder.
CD can appear at any age. The disease affects people differently and the symptoms vary widely. In fact, some patients with the disease may not have symptoms. Any of the following symptoms may be associated with CD:
- Delayed growth in children or failure to thrive in infants
- Chronic diarrhea or constipation; pale, foul-smelling or fatty stool
- Abdominal (belly) pain, bloating and gas
- Irritable bowel syndrome
- Abnormal liver enzymes (ALT/AST)
- Delayed motor development or learning/concentration difficulties in children
- Bone and joint pain; bone disease or fractures
- Depression; behavioral changes or irritability in children
- Unexplained iron deficiency anemia
- Recurrent apthous ulcers (sores inside the mouth)
- Neurological changes; unexplained ataxia or peripheral neuropathy; tingling or numbness in legs; seizures
- Dermatitis herpetiformis (watery, itchy skin blisters)
- Dental enamel defects
- Recurrent pericarditis
In addition to the above mentioned symptoms, patients may present with a variety of nutrition related problems such as:
- Involuntary weight loss
- Lactose intolerance
- Folate or B12 deficiency
- Osteopenia or osteoporosis
Associated Conditions that increase risk of celiac disease:
- Type I diabetes
- Autoimmune thyroid disease
- Down syndrome
- Turner syndrome
- Williams syndrome
- IgA deficiency
- A relative with celiac disease
How is it diagnosed?
Intestinal biopsy remains the gold standard for diagnosing celiac disease. Blood tests, however, are widely used as a first step to screen for celiac disease. These test look for three antibodies common in CD:
Anti-tissue transglutaminase (tTG) antibodies
Endomysial antibodies (EMA)
Antigliadin antibodies (AGA)
Because no one blood test in ideal, panels are often used. If blood tests indicate the possibility of celiac disease, an intestinal biopsy should be done to either confirm or rule out celiac disease. If celiac disease is present the biopsy will show changes to the villi which line the small intestine. To obtain the biopsy an EGD is performed.
For accurate blood and biopsy results, patients must NOT be on a gluten-free diet.
Genetic tests can rule out the possibility of current or future celiac disease in patients for whom other tests do not provide a clear diagnostic result. Genetic tests, however, cannot confirm or diagnose celiac disease.
How is it treated?
The only treatment for CD is a strict gluten-free diet (GFD) for life. A small amount of gluten is enough to cause intestinal damage, even though you may not experience symptoms. It may be more difficult to avoid temptation to eat gluten if you do not have symptoms as a result. Keep in mind that if you do cheat, you run the risk of long-term complications. It is essential that individuals with CD be referred for an initial assessment, education and follow-up with a registered dietitian with expertise in CD and the GFD.
Children’s Digestive Health: www.cdhnf.org
Celiac Disease Awareness Campaign: www.celiac.nih.gov
Celiac Disease Foundation (CDF): www.celiac.org
Celiac Sprue Association (CSA): www.csaceliacs.org
The Gluten Intolerance Group (GIG): www.gluten.net
Celiac Disease and Gluten-Free Diet Information: www.celiac.om
The University of Chicago Celiac Disease Center: www.CeliacDisease.net
Expert Celiac Disease/Gluten-Free Dietitian Sites:
Shelly Case, RD: www.GlutenFreeDiet.ca
Tricia Thompson, MS, RD: www.GlutenFreeDietitian.com
Marlisa Brown, MS, RD, CDE, CDN: www.GlutenFreeEasy.com
To Research Gluten-Free Medications:
Gluten-Free Vitamin Sources:
Kirkman Labs: www.KirkmanGroup.com
Freeda Vitamins: www.FreedaVitamins.com
Carlson Labs: www.CarlsonLabs.com