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What is celiac disease?
Celiac disease is a digestive disease that damages the small
intestine and interferes with absorption of nutrients from
food. People who have celiac disease cannot tolerate a protein
called gluten, which is found in wheat, rye, barley, and
possibly oats. When people with celiac disease eat foods
containing gluten, their immune system responds by damaging
the small intestine. Specifically, tiny fingerlike protrusions,
called villi, on the lining of the small intestine are lost.
Nutrients from food are absorbed into the bloodstream through
these villi. Without villi, a person becomes malnourished–regardless
of the quantity of food eaten.
Because the body's own immune system causes the damage,
celiac disease is considered an autoimmune disorder. However,
it is also classified as a disease of malabsorption because
nutrients are not absorbed. Celiac disease is also known
as celiac sprue, nontropical sprue, and gluten-sensitive
enteropathy.
Celiac disease is a genetic disease, meaning that it runs
in families. Sometimes the disease is triggered–or
becomes active for the first time–after
surgery, pregnancy, childbirth, viral infection, or severe
emotional stress.
What are the symptoms?
Celiac disease affects people differently. Some people develop
symptoms as children, others as adults. One factor thought
to play a role in when and how celiac appears is whether
and how long a person was breastfed–the
longer one was breastfed, the later symptoms of celiac disease
appear and the more atypical the symptoms. Other factors
include the age at which one began eating foods containing
gluten and how much gluten is eaten.
Symptoms may or may not occur in the digestive system. For
example, one person might have diarrhea and abdominal pain,
while another person has irritability or depression. In fact,
irritability is one of the most common symptoms in children.
Symptoms of celiac disease may include one or more of the
following:
- recurring abdominal bloating and pain
- chronic diarrhea
- weight loss
- pale, foul-smelling stool
- unexplained anemia (low count of red blood cells)
- gas
- bone pain
- behavior changes
- muscle cramps
- fatigue
- delayed growth
- failure to thrive in infants
- pain in the joints
- seizures
- tingling numbness in the legs (from nerve damage)
- pale sores inside the mouth, called aphthus ulcers
- painful skin rash, called dermatitis herpetiformis
- tooth discoloration or loss of enamel
- missed menstrual periods (often because of excessive
weight loss)
Anemia, delayed growth, and weight loss are signs of malnutrition–not
getting enough nutrients. Malnutrition is a serious problem
for anyone, but particularly for children because they need
adequate nutrition to develop properly.
Some people with celiac disease may not have symptoms. The
undamaged part of their small intestine is able to absorb
enough nutrients to prevent symptoms. However, people without
symptoms are still at risk for the complications of celiac
disease.
How is celiac disease diagnosed?
Diagnosing celiac disease can be difficult because some
of its symptoms are similar to those of other diseases, including
irritable bowel syndrome, Crohn's disease, ulcerative colitis,
diverticulosis, intestinal infections, chronic fatigue syndrome,
and depression.
Recently, researchers discovered that people with celiac
disease have higher than normal levels of certain antibodies
in their blood. Antibodies are produced by the immune system
in response to substances that the body perceives to be threatening.
To diagnose celiac disease, physicians test blood to measure
levels of antibodies to endomysium and tissue transglutaminase.
If the tests and symptoms suggest celiac disease, the physician
may remove a tiny piece of tissue from the small intestine
to check for damage to the villi. This is done in a procedure
called a biopsy: the physician eases a long, thin tube called
an endoscope through the mouth and stomach into the small
intestine, and then takes a sample of tissue using instruments
passed through the endoscope. Biopsy of the small intestine
is the best way to diagnose celiac disease.
Screening
Screening for celiac disease involves testing asymptomatic
people for the antibodies (see above). Americans are not
routinely screened for celiac disease. However, because celiac
disease is hereditary, family members–particularly
first-degree relatives–of
people who have been diagnosed may need to be tested for
the disease. About 10 percent of an affected person's first-degree
relatives (parents, siblings, or children) will also have
the disease. The longer a person goes undiagnosed and untreated,
the greater the chance of developing malnutrition and other
complications.
What is the treatment?
The only treatment for celiac disease is to follow a gluten-free
diet–that
is, to avoid all foods that contain gluten. For most people,
following this diet will stop symptoms, heal existing intestinal
damage, and prevent further damage. Improvements begin within
days of starting the diet, and the small intestine is usually
completely healed–meaning
the villi are intact and working–in
3 to 6 months. (It may take up to 2 years for older adults.)
The gluten-free diet is a lifetime requirement. Eating any
gluten, no matter how small an amount, can damage the intestine.
This is true for anyone with the disease, including people
who do not have noticeable symptoms. Depending on a person's
age at diagnosis, some problems, such as delayed growth and
tooth discoloration, may not improve.
A small percentage of people with celiac disease do not
improve on the gluten-free diet. These people often have
severely damaged intestines that cannot heal even after they
eliminate gluten from their diet. Because their intestines
are not absorbing enough nutrients, they may need to receive
intravenous nutrition supplements. Drug treatments are being
evaluated for unresponsive celiac disease. These patients
may need to be evaluated for complications of the disease.
To view this
excellent article on celiac disease, produced by the National
Digestive Diseases Information Clearinghouse, please click
here: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm
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