What Is Celiac Disease?
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When patients with this condition consume food or use products that contain gluten, it triggers an immune system response that damages or destroys the fingerlike protrusions that are found in the lining of the small bowel (villi). Healthy villi allow nutrients consumed through food to be absorbed into the bloodstream through the walls of the small bowel. When healthy villi become damaged or destroyed, the person can become malnourished.
There are over 300 symptoms that have been associated with this condition and symptoms vary among patients. Digestive symptoms are more common in children and often include:
- Chronic diarrhea
- Abdominal cramping and bloating
- Foul-smelling or fatty stool
- Weight loss
Proper absorption of nutrients is vital for normal growth and development in children; therefore malabsorption during childhood can lead to problems such as a failure to thrive in infants, delayed growth and puberty, and dental enamel defects of permanent teeth.
On the other hand, adults are less likely to experience digestive symptoms and are more likely to present with signs and symptoms such as:
- Anemia (decreased red blood cell count)
- Bone or joint pain
- Anxiety or depression
- Tingling or numbness in the hands or feet
- Oral canker sores
- Skin rash (dermatitis herpetiformis)
- Missed menstrual cycles
- Infertility or recurrent miscarriage
Diagnosis of celiac disease begins with a medical history (including family history) and physical examination. If this condition is suspected, the physician may order laboratory (blood) tests to look for certain antibodies in the blood that indicate an abnormal immune reaction to gluten. These blood tests are very sensitive and can detect celiac disease in patients who exhibit minimal to no symptoms.
If the laboratory results indicate celiac disease, an endoscopy may be ordered to view the small bowel; a biopsy may be taken during this procedure to visualize villi damage. Capsule endoscopy is another test that may be utilized; this test uses a small wireless camera to take pictures of the small intestine. The camera is positioned inside a capsule that is swallowed by the patient. As the capsule moves through the gastrointestinal tract, it takes pictures that are transmitted for the physician to view.
Early diagnosis and treatment of celiac disease is imperative because if this condition is left untreated, patients may develop further complications including osteoporosis, thyroid disease, and cancer.
What Causes Celiac Disease?
The exact cause of celiac disease remains unknown. However, this condition tends to run in families, suggesting that there may be a genetic link. Researchers have found that some gene mutations appear to increase the risk of developing celiac disease. However, having these mutations does not necessarily mean an individual will develop this condition; therefore, other factors must be involved.
In some patients, celiac disease is triggered, or becomes active for the first time following pregnancy, childbirth, surgery, viral infection, or intense emotional stress.
Often patients with this condition have other autoimmune diseases, including:
- Type I diabetes
- Autoimmune liver disease
- Autoimmune thyroid disease
- Rheumatoid arthritis
- Sjogren’s syndrome
- Addison’s disease
The link between celiac disease and these diseases may be genetic in nature.
Treatments For Celiac Disease
There is no cure for this condition, but it can usually be effectively managed by consuming a diet free from gluten. When a patient is first diagnosed with celiac disease it is beneficial for them to meet with a dietitian who can help them to manage their diet appropriately.
Patients with this condition must be aware of hidden sources of gluten in products (i.e. hydrolyzed vegetable or plant protein, kaput, spelt, malt, etc.). Before consuming food or using products, patients with celiac disease need to carefully read ingredient labels. A dietitian can help patients to understand food sources of gluten and can teach patients how to read food labels properly.
It is important for patients with this condition to remember that even though they may not have symptoms, damage may still occur to the intestinal lining with the consumption or use of gluten products.
Occasionally, a patient’s symptoms of celiac disease may be unresponsive to a diet free from gluten. This may signal that traces of gluten are hiding in their diet. Rarely, when there is severe damage to the intestinal wall, it is unable to heal; when this occurs, it is referred to as refractory celiac disease. In these cases, patients may require intravenous nutrition. Additionally, some patients may require steroids to help heal mucosa that has been damaged by the disease. Patients who suffer from dermatitis herpetiformis may be prescribed a topical medication to help control the itching.
A referral to a gastroenterologist may be warranted for patients who have celiac disease that is unresponsive to dietary changes. Gastroenterologists can conduct additional diagnostic testing and may recommend alternative treatment options for these patients.
Celiac disease is an autoimmune disease that damages the small bowel and interferes with nutrient absorption when an individual consumes food or uses products that contain gluten. Symptoms of celiac disease vary widely among patients, with children exhibiting more digestive symptoms and adults experiencing a wide variety of other symptoms.
At the present time, there is no cure for this condition; however, it can often be effectively managed with a diet that is free from gluten. Patients experiencing symptoms of celiac disease are encouraged to speak to their physicians as an accurate and early diagnosis may help to prevent complications that are associated with this condition.
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