Introduction
Celiac disease occurs when the lining of the intestinal tract becomes inflamed and damaged. The damage to the intestinal lining is caused by the patient’s allergic reaction to a specific chemical named gluten. Gluten is found in many foods; specifically, wheat, rye, barley and some oats. Therefore, any foods made with these ingredients can cause the patient to have an allergic reaction.
This allergic reaction varies from patient to patient. It may be mild, with the patient presenting with only a grumbly stomach. It may be life threatening and cause damage to the body through methods such as anaphylactic shock or encephalitis. Patients with celiac disease may also present with a wide range of symptoms that fall anywhere between these two extremes.
Causes
The intestinal tract is lined with villi, tiny little finger-like cell parts that grab nutrients from the food we eat. These very small structures absorb nutrients to power cells. When a person with celiac disease eats gluten, their immune system reacts by attacking and damaging the villi. Since the damage to the villi will often be imperceptible, additional reactions to ingested gluten will compound the problem. Until the person abstains from gluten entirely, their symptoms will not improve.
The disease can develop at any time in a person’s life, from infancy to adulthood. It is not thought to be a genetic disease; however, a person with a family member that has celiac disease is at greater risk of developing the disease. Caucasians and persons of European ancestry are also at higher risk, and women are more likely than men to have the disorder.
People with celiac disease frequently have one or more of the following diseases as well:
Down syndrome
Addison disease
Intestinal lymphoma
Intestinal cancer
Rheumatoid arthritis
Systemic lupus
Erythematosus
Sjogren syndrome
Thyroid disease
Type 1 diabetes
Lactose intolerance
Signs and Symptoms
Each person experiences different symptoms due the severity of their condition. They may have all or none of the following early symptoms:
Diarrhea – ranging from loose to watery stools, either intermediate or constant
Constipation (also ranging in severity)
Loss of appetite
Increased appetite
Stomach pain
Gas or bloating
Indigestion
Lactose intolerance
Nausea and vomiting
Foul smelling stools
Oily, sticky or stringy stools
Unexplained weight loss
Other problems may develop over time. Because nutrients are not being absorbed properly, a person’s general health can begin to deteriorate.
Easy and excessive bruising
Nosebleeds
Muscle cramps
Joint pain
Delayed growth in children
Hair loss
Itching and skin rashes
Seizures
Numbness and tingling in hands and feet
Fatigue
Malaise
Depression
Anxiety
Mouth sores/ulcerations
Amenorrea
Tests and Exams
If celiac disease is suspected, tests may be ordered to determine a diagnosis. The following are the most common tests:
Comprehensive metabolic panel (CMP)
Complete blood count (CBC)
Folate level
Iron level
Prothrombin time (PTT)
Cholesterol
Vitamin B12 level
Vitamin D level
Bone Density
Antitissue tansglutaminase antibodies (tTGA)
Anti-endomysial antibodies (EMA)
Endoscopy with biopsy
Typically the blood work is drawn and sent to the lab first. If the blood work tests positive for tTGA or EMA and the lab tests are abnormal then a patient will have an upper endoscopy with biopsy. A long scope is inserted down the esophagus, past the stomach and into the duodenum. A small sample piece of the lining of the intestinal tract is removed to view under a microscope. The biopsied tissue may show a flattening of the villi, which is common in patients with celiac disease. Additional genetic testing may be done after diagnosis is confirmed by biopsy.
A follow-up biopsy may be ordered at 6 months, to ensure that treatment is working. Patients that have recovered and have abstained from gluten will present with improved villi.
Treatment
There is no cure for celiac disease; however, symptoms may be more manageable or even disappear completely with treatment. Treatment can be difficult for some patients to adhere to, as the patient must abstain from gluten entirely.
Getting help from a registered dietician or nutritionist is an important part of getting well. A dietician will support and advise the patient on their food choices and teach them to read nutritional labels. By maintaining a healthy lifestyle, eating a well balanced diet and cutting out gluten entirely, the villi can heal and the patient can live symptom free.
Prognosis
By adhering to the gluten free diet, no further damage will occur and the intestines will begin to heal. It does take time, but typically, within two years, the villi are back to full health and the patient is symptom free.
Possible Complications
It is important for the patient to understand the implications of ingesting gluten. Any reintroduction of the substance will cause symptoms to immediately recur. Complications can be life threatening. Some common complications are:
Intestinal cancer
Anemia
Autoimmune disorders
Osteoporosis
Infertility/miscarriages
Liver disease
References:
Celiac Disease (Gluten Intolerance). Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024528/.
Volta, U. et. al. (2016). Features and Progression of Potential Celiac Disease in Adults. Clin. Gastroenterol. Hepatol., 14 (5), 686-693. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26538207.
What is Celiac Disease? Retrieved from https://medlineplus.gov/magazine/issues/spring15/articles/spring15pg3.ht…
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