What is Celiac disease?
Celiac disease is a condition where the immune system responds abnormally to a protein called gluten. Damage to the lining of the small intestine occurs when affected individuals consume gluten. Over time, this leads to flattening of the intestinal villi, or finger-like cells responsible for absorbing nutrients from our food. As a result, malabsorption of nutrients normally absorbed in the small intestines occurs, and nutritional deficiencies can develop (things like iron and B12 deficiencies).
What is malabsorption?
Malabsorption is when you’re not able to absorb nutrients properly from the food that you eat. There are many different types of malabsorption syndromes or reasons why malabsorption happens. Celiac disease is one of these conditions.
The small intestine is responsible for absorbing food and nutrients from our food sources. Damage to the lining of the small intestines secondary to exposure to gluten can lead to difficulty absorbing important nutrients from the foods that we eat, things like iron, B12, folic acid, calcium, and zinc. These nutrients are crucial for our cells to function properly. For example, without iron we cannot make new hemoglobin molecules, and hemoglobin is responsible for carrying oxygen to our tissues. Without enough hemoglobin we can become anemia. Without sufficiency B12, we can’t make new red blood cells because B12 plays an important role in producing new cells. Without enough calcium, our bones can become weak and osteopenia and osteoporosis can result.
Although celiac disease cannot be cured, avoiding gluten usually stops the damage to the intestinal lining and the malabsorption that results. Treatment for celiac disease involves following a strict gluten-free diet to prevent complications of the disease.
Where is gluten found?
Gluten is found in wheat, rye, barley, and a multitude of other prepared foods.
Who is at risk for Celiac Disease?
Celiac disease can occur in people of any age and it affects both men and women.
Celiac disease occurs widely in Europe, North and South Americas, Australia, North Africa, the Middle East, and in South Asia. Celiac disease is rare in people from other parts of Asia or sub-Saharan Africa.
What are the symptoms of Celiac Disease?
Symptoms can vary from one person to another.
Common symptoms include:
- Weight loss,
- Gas, bloating,
- Abdominal discomfort or distention,
- Infertility, and
- Other signs and symptoms caused by vitamin and nutrient deficiencies such as brittle nails, pale skin, dry, flaking skin, acne, fatigue, weakness, sluggishness, and shortness of breath (in the case of anemia).
Are there any conditions more common in people with Celiac Disease?
Yes. Some of these conditions include:
- Osteopenia or osteoporosis (weakening of the bones)
- Iron deficiency anemia (or a low red blood cell count due to a lack of iron in the body)
- Diabetes mellitus (especially Type 1 or insulin dependent diabetes mellitus)
- Thyroid problems (usually hypothyroidism or an underactive thyroid)
- Dermatitis herpetiformis (a skin rash classic of celiac disease)
- Nervous system disorders
- Liver disease
What causes Celiac Disease?
It is not clear exactly what causes celiac disease. A combination of environmental and genetic factors likely contributes to the disease.
How is Celiac Disease Diagnosed?
Celiac disease can be difficult to diagnose. Testing is available to distinguish untreated celiac disease from other disorders.
Blood tests include:
- Antigliadin IgA antibodies
- Deamidated gliadin IgA
- Antigliadin IgG antibodies
- Deamidated gliadin IgG
- Anti-tissue transglutaminase IgA (or tTG)
- Anti-endomysial IgA antibodies
- Total serum IgA
- Genetic testing for HLA-DQ2 and HLA-DQ8
These blood tests measure antibodies, or specific parts of your immune system, to see if your body is reacting to (or producing antibodies in response to) gluten.
Small intestine biopsy is the Gold Standard test for diagnosing celiac disease.
If one of more of your blood tests is positive, the diagnosis of celiac disease must be confirmed by taking a biopsy or sample of the lining of your small intestine during an upper endoscopy or EGD.
In people with celiac disease, the lining of the small intestine has a characteristic appearance when viewed under a microscope. Normally, the lining of the small intestines has distinct finger-like villi that allow the small intestine to absorb nutrients. In celiac disease, the villi become flattened. Once you stop eating gluten, the villi can return back to normal. If you have positive blood testing and flattened villi a diagnosis of celiac disease can be made.
What are the potential complications of Celiac Disease?
- Iron Deficiency
- B12 Deficiency
- Vitamin D Deficiency
- Liver Disease
- Ulcerative jejunitis: This condition causes the small intestine to develop multiple ulcers that do not heal. It can be difficult to treat and may require surgery to remove the ulcerated area.
- Lymphoma: Cancer of the intestinal lymphatic system is an uncommon but serious complication of celiac disease. Avoiding gluten can usually prevent this complication.
- Skin conditions: Celiac disease is associated with a number of skin disorders.
- Dermatitis herpetiformis is the most common. Dermatitis herpetiformis is characterized by intensely itchy, raised, fluid-filled areas on the skin, usually located on the elbows, knees, buttocks, lower back, face, neck, trunk, and occasionally within the mouth. The condition improves after eliminating gluten from the diet.
- Acne is also more common.
Why is early diagnosis of Celiac disease so important?
If diagnosed early, some of the complications of the disease can be prevented just by avoiding gluten.
What is the treatment for Celiac Disease?
Following a gluten-free diet. The cornerstone of treatment for celiac disease is complete elimination of gluten from the diet for life. Maintaining a gluten-free diet can be challenging. Establishing care with a nutritionist may be helpful.
Is gluten avoidance really necessary?
Yes, avoiding gluten is crucial to help prevent complications from the disease. Following a gluten-free diet will help to prevent nutritional deficiencies and anemia. It can help you to feel better and to have more energy. Remember, untreated celiac disease can increase your risk for developing certain types of GI cancer including lymphoma. This risk is greatly reduced by following a strict gluten-free diet.