Celiac Disease: Symptoms, Diagnosis and Treatment
Celiac disease is an immune-mediated condition which damages your small intestine. It is triggered by eating gluten-containing foods. Gluten is a natural protein found in wheat, barley, rye, products derived from these, and it is also used as an industrial ingredient in certain non-edible products. The patient complains of tiredness, nutrients deprivation, bloating, anemia, and much more. It is different from gluten sensitivity in which there is no damage to the small intestine but symptoms are similar. Celiac disease is a lifelong disease and has varied complications. Every one out of 141 Americans has celiac disease, but many of them are unaware of it.
Signs and symptoms of Celiac Disease
They vary greatly and are different for children and adults
For children, they mainly show digestive symptoms like
- Chronic diarrhea
- Bloating
- Swelling in the abdomen
- Nausea and vomiting
- Failure to thrive
- Steatorrhea – pale, foul-smelling, or fatty stools
- Abdominal pain
- Non-digestive system symptom – due to lack of nutrients
- Weight loss
- Short height
- Delayed puberty
- Damage to permanent teeth’s enamel
Adults are less likely to have digestive symptoms abdominal pain, bloating, diarrhea, weight loss but more than half of them shows symptoms related to
Bones – increased chances of fracture due to decreased bone density or softening of bones
Joints – Pain in joints
Blood – anemia causing fatigue
Nervous system – tingling sensation in the hands and feet, anxiety or depression
Reduced functioning of the spleen
Skin – dermatitis herpetiformis
Rash: Dermatitis herpetiformis, is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks or other parts of body. This rash affects about 10 percent of people with celiac disease. Some people suffering from celiac disease may only show signs of rash with no other symptoms
Causes of Celiac Disease
It is observed by researchers that celiac disease occurs to those who have specific genes.
Though these genes are common in one-third of the population, it is thought that disease occurs due to interaction among various factors like genes, the environment, eating food containing gluten.
Celiac disease doesn’t always show symptoms after eating gluten. Sometimes it becomes active for the first time after surgery, childbirth, pregnancy, emotional stress or viral infection.
Risk factors of Celiac Disease
Gender: Females are more affected than males
Race: Caucasians are at higher risk
Family history: your chances of getting celiac disease increase if your family member has it.
Other medical conditions: Celiac disease is more common in people having certain diseases like type 1 diabetes, down syndrome, Hashimoto’s disease
Complications of Celiac Disease
If your celiac disease is uncontrolled, there are a high chance of these complications
Malnutrition: weight loss, emaciation, anemia because your diseased intestine is not able to absorb the nutrition
Fractures: decreased bone density due to malabsorption of calcium and vitamin D
Infertility or problems related to reproduction.
Neurological problems like seizures or peripheral neuropathy
Intestinal cancer (rare complication)
Refractory celiac disease – the symptoms still persist when you are eating a strict gluten-free diet. This shows that your intestines are strictly damaged and you may need to receive nutrition via an IV line
Diagnosis of Celiac Disease
Your doctor will ask you some questions related to your medical history, conduct a physical exam, and medical test to diagnose it.
Medical history: Your doctor will ask you many questions related to your symptoms, bowel habits, family history
Physical examination: Basically, your doctor will check your abdomen for tenderness, swelling or distension and check your body for the sign of malnutrition or rashes.
Laboratory Test
Blood test: your blood sample will be used for
Serologic test: To look for antibodies that are commonly found in Celiac disease
Genetic test: if antibodies or biopsy don’t clearly confirm the diagnosis, then the presence of certain genes or variants can be checked. The absence of variants can be used to rule out celiac disease but presence doesn’t mean that you have celiac disease as they are present in the common population also.
Intestinal biopsy: your doctor will take a small piece of tissue from the intestine to look for the changes
Treatment and prognosis of Celiac Disease
Celiac disease cannot be treated; it can be managed only.
A gluten-free diet – a strict gluten-free diet can be used to manage the disease. Your doctor will advise you to seek the help of a dietician to make you a proper plan of a gluten-free diet. After following a gluten-free diet, the symptoms get to improve in most of the people. Complete healing can take several years i.e. for the growth of villi. Even traces of gluten are harmful. After complete healing it does not mean that you are treated, your symptoms can appear again if you again start eating a gluten-containing diet. That’s why it is called that celiac disease can only be managed.
Avoid nonfood products containing gluten – gluten is also used in non-edible products like lip balms, hair and skin products, toothpaste. Some medications also contain gluten.
Medications to control inflammation – if your intestine is severely damaged then your doctor can prescribe you some steroid medications for a short period of time. These medications are the only known way to manage the refractory celiac disease but still, it cannot be managed fully.
Reference
- Association analysis of the extended MHC region in celiac disease implicates multiple independent susceptible loci. PLoS ONE. 2012;7(5): e36926.
- ACG Clinical Guidelines: diagnosis and management of the celiac disease. American Journal of Gastroenterology. 2013;108(5):656–676.
- Celiac Disease, Wheat Allergy, and Gluten Sensitivity: When Gluten-Free Is Not a Fad. Journal of Parenteral and Enteral Nutrition. 2012; 36:68S-75S.
- The prevalence of the celiac disease in the United States. American Journal of Gastroenterology. 2012;107(10):1538–1544.
