Celiac Disease, Celiac Sprue, and Gluten Sensitivity
Celiac disease is the most common food intolerance in the United States. It also seems to be a common source of confusion for many who may be affected.
The Basics
Gluten is a protein found in wheat, barley and rye. In people with celiac disease, gluten damages the small intestine and interferes with absorption of nutrients from food. It is a problem of both malnutrition as well as an abnormal immune response.
An estimated 1% of the U.S. population has celiac disease, and for unclear reasons it seems to be on the rise.
Who is at Risk for Celiac Disease?
If a person has a parent, sibling or child with celiac disease, they have a 1 in 22 chance of developing celiac disease. People with a related autoimmune disorder or other genetic conditions are at increased risk as well: these include: Type 1 diabetes, Autoimmune thyroid or liver conditions, Rheumatoid arthritis, Addison’s disease, Sjogren’s syndrome, Down syndrome and Turner syndrome.
The majority of those diagnosed with celiac disease are not considered at “increased risk,” but were diagnosed because they were having symptoms.
What are the Symptoms?
The symptoms of celiac disease vary widely. Scientists are studying the reasons for this, but some factors may be a person’s age or the degree of damage to the intestine.
A person may have “typical” symptoms such as:
- Chronic diarrhea
- Weight loss
- Pale, fatty, foul-smelling stools
- Abdominal bloating and pain
- Dermatitis Herpetiformis: an itchy, blistering skin rash
Or, more commonly, a person may have more non-specific symptoms such as:
- Iron-Deficiency Anemia
- Fatigue
- Joint/Bone pains
- Osteoporosis
- Depression or Anxiety
- Tingling or numbness in the hands and feet
- Seizures
- Missed menstrual periods
- Infertility or recurrent miscarriage
- Canker sores inside the mouth
How Do We Diagnose Celiac Diseae?
If your doctor suspects celiac disease, she may order some Blood Tests and obtain tissue biopsies.
Blood Tests:
- tTg/EMA: People with celiac disease have elevated levels of certain antibodies, tissue transglutaminase (tTG) or anti-endomesial antibody (EMA.) As long as gluten is being ingested, these antibodies can be detected at elevated levels in the blood.
- HLA DQ2/DQ8: If the tTG or EMA is normal, but your doctor still highly suspects celiac disease, then certain blood tests to check for genetic markers may be useful.
Tissue Biopsy:
- If blood tests indicate celiac disease, tiny biopsies of the small intestine are obtained using an endoscope to confirm the diagnosis.
Why Do We Treat Celiac Disease?
Naturally, one reason that we treat celiac disease is to relieve a person’s symptoms. However, the other reason to treat is to avoid long term complications. These may include:
- Malnutrition
- Anemia
- Osteoporosis
- Miscarriage
- Liver Problems
- Rarely: Cancer of the Intestine
How Do We Treat Celiac Disease?
The only proven treatment is lifelong avoidance of gluten. Because even a small amount of gluten can damage the intestines, it is important not to eat foods, such as pasta, grains, cereals and many processed foods or other products, such as medications, which contain this protein.
Despite the restrictions in a gluten-free diet, people can eat a wide array of plain meat, fish, rice, fruits and vegetables. There are many “gluten-free” versions of their favorite foods available as well. A nutritionist may help guide them as they learn to make the right food choices.
If you have further questions or are concerned that you may be affected by celiac disease, call your gastroenterologist (that’s us) at 301-251-9555
