The following article is brought to you by Allied Digestive Health.
In May we recognize Celiac Disease Awareness Month, with a hope to improve public perception of this serious autoimmune disorder that is estimated to affect 1 in 100 people worldwide. It occurs in those who are genetically predisposed.
With celiac disease, the ingestion of gluten leads to an immune response that causes damage to the small intestine. Gluten is a protein found in wheat, barley, and rye. It is naturally occurring but can also be extracted and is often added to other foods for additional protein, texture, and flavor.
When people with celiac disease eat foods containing gluten, their immune system responds by attacking the small intestine, specifically the villi, small fingerlike projections that line the intestine and promote nutrient absorption.
Over time, damage to the lining of the small intestine may prevent it from properly absorbing nutrients, resulting in a condition called malabsorption.
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Signs and Symptoms of Celiac Disease
Symptoms of celiac disease can vary widely and differ in children and adults. Digestive symptoms are common in both adults and children, but children are more likely to have these than adults.
Common digestive symptoms found in children with celiac disease include nausea and vomiting, chronic diarrhea, swollen belly, constipation, gas, and pale, foul-smelling stools.
Common digestive symptoms found in adults with celiac disease are similar, and include diarrhea, fatigue, weight loss, bloating and gas, abdominal pain, nausea and vomiting, and constipation.
More than half of adults may also have symptoms unrelated to the digestive system, such as anemia (caused by iron deficiency due to poor absorption of iron), osteoporosis (loss of bone density), itchy skin rashes (dermatitis herpetiformis), headaches, fatigue, mouth ulcers, joint pain, and acid reflux.
Adults may also have reduced functioning of the spleen (hyposplenism), elevated liver enzymes, or a nervous system injury, including numbness and tingling in the feet and hands, problems with balance, and potential cognitive impairment.
In children, the inability to absorb nutrients may result in a failure to thrive in infants, damage to the enamel of the teeth, weight loss, anemia, irritability, short stature, delayed puberty, or neurological symptoms, which may include attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, impairment of muscle coordination, and seizures.
How Celiac Disease Is Diagnosed
Many people living with celiac disease don’t know they have it, and it is thought that only about 30% of people with celiac disease are properly diagnosed. Diagnosing celiac disease involves several steps.
Initially, blood tests are used to look for antibodies typically present in the blood of people with celiac disease. The first test is usually the Tissue Transglutaminase IgA antibody (tTG-IgA), plus an IgA antibody in order to ensure that the patient generates enough of this antibody to render the celiac disease test accurate.
IgG antibodies should also be included for young children (about 2 years old and younger). The tTG-IgA test is highly specific to celiac disease.
Due to the possibility of false positive and false negative results, other antibody tests are available to help diagnose celiac disease.
The IgA Endomysial antibody (EMA) is the most specific test for celiac disease but is usually reserved for difficult to diagnose patients because it is expensive and not as sensitive as the tGG-IgA antibody test.
The total serum IgA test is used to check for IgA deficiency, a condition associated with celiac disease that can cause a false negative tTG-IgA or EMA result.
The deamidated gliadin peptide test (DGP IgA and IgG) can be used to further screen for celiac disease in individuals with an IgA deficiency, which affects 2-3% of patients with celiac disease, or people who test negative for tTg or EMA antibodies.
If blood tests indicate celiac disease, an endoscopic biopsy of the small intestine is often performed to confirm the diagnosis and assess the degree of damage to the villi.
This is where a tissue sample is taken from your small intestine to check for damage to the villi. Genetic tests can also support diagnosis or to rule out celiac disease.
Further medical evaluation may be necessary for some individuals with celiac disease who have negative antibody test results. A biopsy is the most accurate way to test for celiac disease.
An endoscopy may be used, including video capsule endoscopy (VCE), which is also useful in detecting complications linked with celiac disease. VCE has a sensitivity of 89% and specificity of 95% for celiac diagnosis.
Some radiological findings may also be used to indicate the presence of celiac disease, such as small-bowel dilation, wall thickening, vascular changes, and others.
How Does Celiac Disease Affect My Body?
In celiac disease, eating gluten triggers an immune reaction that causes the body to attack the small intestine, damaging or destroying the villi. This damage hinders the body's ability to absorb nutrients effectively, leading to malnutrition and a variety of secondary health issues.
The villi are tiny, finger-like projections that cover the mucosa (lining) of the small intestine (also called the small bowel). The cells on villi are responsible for breaking down and absorbing nutrients in food. If you have celiac disease, the mucosa of your small intestine becomes damaged.
This causes inflammation of the villi, known as villous atrophy. As a result of this inflammation, the surface area of your small intestine is reduced, seriously reducing the ability of the villi to absorb nutrients and minerals.
This can lead to nutritional deficiencies, which can, in turn, lead to various secondary, long-term complications.
Is Celiac Disease Serious?
Yes, celiac disease is considered a serious medical condition. If it is left untreated, it can lead to a variety of complications; not only secondary conditions due to nutritional deficiencies, but chronic inflammation can also lead to an increased risk of gastrointestinal cancers, liver disease, compromised immunity and developing other autoimmune conditions, additional food intolerances, and neurological conditions.
Nonresponsive celiac disease occurs when people don't respond to what they consider to be a gluten-free diet. It is likely due to contamination of the diet with gluten.
Those with nonresponsive celiac disease may have bacterial overgrowth in the small intestine, irritable bowel syndrome, microscopic colitis, pancreatic insufficiency, or difficulty digesting sugar.
Refractory celiac disease is a rare complication where symptoms persist or recur despite strict adherence to a gluten-free diet, and often requires additional treatment.
Management and Treatment
The primary treatment for celiac disease is a strict gluten-free diet, which involves avoiding all foods with wheat, barley, and rye. Adhering to this diet can help manage symptoms and promote intestinal healing.
In cases of refractory celiac disease or severe symptoms like dermatitis herpetiformis, additional treatments may include medications to suppress the immune system or medications specifically to treat dermatitis herpetiformis.
Ongoing follow-up with healthcare providers, including dietitians familiar with celiac disease, is crucial to ensure nutritional needs are met and to monitor any potential complications.
When to Talk to Your Doctor
It is essential to consult with a healthcare provider if you suspect you or your child may have celiac disease, especially if there is a family history of the disease or other autoimmune conditions, as celiac disease is genetic.
Ongoing symptoms such as diarrhea, abdominal pain, unexplained weight loss, or fatigue should prompt you to schedule a visit with a doctor. However, you may have celiac disease and not have any symptoms.
While celiac disease is genetic, other risk factors have been identified. Celiac disease tends to be more common in people who have, type 1 diabetes, Down syndrome, William syndrome, Turner syndrome, an autoimmune thyroid disease such as Hashimoto’s, microscopic colitis, or Addison's disease.
If you or a family member has one of these risk factors, it is you should talk to your doctor now about celiac disease.
Remember, talking to your doctor now can ensure early diagnosis and treatment, which are crucial for helping to prevent serious health complications associated with celiac disease. Don’t hesitate to reach out to a healthcare professional today to learn more about the signs, symptoms, and risk factors of celiac disease.
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