What is celiac disease?

Celiac disease is a chronic intestinal illness that is the result of an immune response to gliadin, a gluten protein found in wheat, barley, rye and sometimes oats.

It causes inflammation and deterioration of the small intestine’s inner lining, and can lead to mineral which nutrient malabsorption.

Symptoms could include chronic diarrhea, weight loss and tiredness. In some cases the only symptom is anemia, and it is not until later in life that celiac disease is diagnosed.

Around 1 in 141 Americans are affected by celiac disease. It can affect a genetically predisposed person of any age, but it often starts in middle infancy.

There’s no solution and a gluten-free diet is the only effective treatment.

Fast facts on celiac disease:

Here are some key points about celiac disease. More detail is in the main article.

  • Celiac disease is an autoimmune disorder that causes people to become intolerant to gluten.
  • Long-term effects include anemia and malnutrition.
  • The only effective treatment is a gluten-free diet.
  • A gluten-free diet is only recommended for people who have a gluten allergy or intolerance.
gluten-containing bread
People with celiac disease need to avoid the gluten-containing bread and other foods.

Celiac disease is a chronic condition. Symptoms may range from mild to extreme, can change over time and may vary from individual to individual. Many people may have no symptoms, or they may not show symptoms until later in life.

Some typical celiac symptoms include:

  • gastrointestinal symptoms, such as abdominal cramps, diarrhea, gas, nausea and vomiting, and bloating
  • foul-smelling stools with excess fat in them
  • bone and joint pain
  • depression, irritability, and panic attacks
  • weakness and fatigue
  • easy bruising and nose bleeds
  • fluid retention
  • infertility
  • persistent hunger
  • iron deficiency anemia
  • malnutrition and nutrition deficiencies, including a lack of vitamin B12, D, and K
  • mouth sores and tooth discoloration
  • muscle wasting, muscle weakness, and muscle cramps
  • nerve damage, leading to tingling in the legs and feet
  • blood in the stools or in the urine
  • migraine headaches

Several people develop skin rash, known as herpetiformis dermatitis (DH). Orange, red, and blistering patches can affect the elbows, knees, shoulders, buttocks, and faces.

Celiac disease can result in malabsorption and malnutrition, large intestine damage and subtle damage to other organs.

Many individuals with mild symptoms experience tiredness and anemia, or perhaps only vague abdominal discomfort such as bloating, abdominal distention and excess gas. Many people have no obvious signs of illness but a general sense of unwellness.

Variations in symptoms may may depend on:

  • the length of time a person was breastfed, as symptoms tend to appear later in those who were breastfed for longer
  • the amount of gluten consumed
  • the age at which a person starts eating gluten
  • the level of damage to the small intestine

According to a study published in JAMA Neurology, people with celiac disease may be at a greater risk for neuropathy.

Stress and anxiety can be causing symptoms.

Symptoms in infants and children

There may be intestinal issues in children and infants, such as diarrhea, irritability, and a failure to thrive, or delayed growth.

In time, kids may experience weight loss, tooth enamel damage and delayed puberty.

Diagnosis

The doctor may assess the patient and talk about signs and symptoms, and may ask for some tests.

Blood tests may detect:

  • antigliadin antibodies
  • endomysial antibodies
  • anti-tissue transglutaminase antibodies

Blood is tested for deamidated gliadin peptide (TTG) antibodies, and sometimes antigliadin (AGA) and and andomysium (EmA) antibodies.

A small bowel biopsy is considered as the most accurate test for celiac disease. The doctor uses endoscopy to take bowel samples. In general, multiple samples are obtained to enhance diagnostic accuracy.

Conditions which have symptoms similar to celiac disease include:

  • pancreatic insufficiency
  • Crohn’s disease of the small intestine
  • irritable bowel syndrome
  • small intestinal overgrowth of bacteria
  • gluten sensitivity, which has similar, but milder symptoms and is being debated as an entity

Before making a decision the doctor will exclude these possibilities.

Diet

At present the only treatment for life is to avoid gluten.

The intestines will usually recover with strict dietary observance and symptoms will disappear but eating gluten will cause a relapse again.

Patients need to be aware of which foods contain gluten and which do not, but as many products contain hidden gluten this can be difficult.

A professional dietitian may help a person suffering from celiac disease adopt a healthy diet.

Products with and without gluten

A wide range of labelled gluten-free products are available. This includes gluten-free breads, noodles, cookies etc. Manufacturers must provide details on the ingredients used to produce their food products, but consumers must carefully check the label before buying or eating any product.

Gluten-free alternatives to bread, flour, pasta, and other foods are now widely available.
Gluten-free alternatives to bread, flour, pasta, and other foods are now widely available.

“Gluten-free” normally indicates that the level of gluten is harmless rather than totally absent.

Regulations on the use of gluten-free product labelling vary across countries, so patients should take caution.

A person taking a gluten-free diet should avoid:

  • all foods made from wheat, rye, bran, enriched flour, bulgur and barley, including cereals, breads, pasta, croutons, crackers, cakes, and cookies
  • beer and other grain-based alcohol
  • oats

Some preparations for the oat may be tainted with wheat. In some cases under medical supervision small quantities of oats are added into the diet.

Most food products processed for facilities that produce gluten-containing products should be treated with care.

Gluten is found in many processed foods, including:

  • canned soups
  • salad dressings, ketchup, and mustard
  • soy sauce
  • seasonings
  • ice cream and candy bars
  • processed and canned meats and sausages

Gluten may also be used in:

  • some prescription and over-the-counter (OTC) medications
  • vitamin products
  • cosmetic products such as lipstick, lip gloss, chapstick, and toothpaste
  • postage stamps

People with celiac disease often have lactose sensitivity so it may help to avoid lactose.

Anyone with celiac disease should carefully read the food labels and check which foods are gluten-free in restaurants. Some restaurants have a menu which is gluten free.

A gluten-free diet for all?

Those who have no celiac disease or confirmed gluten intolerance should talk to their doctor if they think of “going gluten-free.” A gluten-free diet may contribute to other defects, if not closely observed.

“No current data indicates that the general public can adopt a gluten-free diet for weight loss or better health,” the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports.

Foods that are safe to consume

It is safe to consume cereals such as maize, millet, sorghum, teff, rice, and wild rice.

Like potatoes and bananas, tapioca, and garbanzo beans, non-cereals such as amaranth, quinoa, or buckwheat are harmless too. These are gluten-free and do not cause symptoms.

A person with celiac disease can need to take supplements with vitamins and minerals to reduce the risk of disorder-caused deficiencies.

Gluten-free dishes can be made by adjusting ingredients and altering the time and temperature used to bake.

Treatment

Researchers investigate drugs that work directly in the intestines, treatments that affect the immune system, and vaccines for the prevention of celiac disease.

There’s no therapy at all, though, except to prevent gluten.

This can affect their quality of life if the person continues to eat gluten, and may increase the risk of some medical conditions.

Complications

Hair loss, anemia, and osteoporosis can occur because the body does not absorb nutrients effectively. Small bowel ulcers may develop.

Celiac disease has been linked to certain types of cancer, including intestinal lymphoma and adenocarcinoma of the small intestine, of the pharynx, and of the esophagus.

Refractory disease

Refractory disease can occur in rare cases, if no action is taken to manage celiac disease. This most commonly happens because a fully gluten-free diet can be difficult to maintain.

The disorder has been present in people with refractory disease for so long that the intestines can no longer regenerate on the diet alone and a gluten-free diet won’t help.

Medications may be prescribed, such as corticosteroids and immunosuppressive medications.

Children with celiac disease

Left untreated, celiac disease in infancy may result in small height in adulthood, but a child with celiac disease who transitions to a gluten-free diet frequently begins to grow in height and overcome any delay induced by the condition. Intestinal damage starts healing within weeks of removing gluten from the diet.

As time goes by, children can undergo spontaneous remissions and remain free up to later in life from the signs and symptoms of celiac disease, but symptoms will later reappear.

Causes

Celiac disease represents an immune disorder. When a person with celiac disease eats gluten their cells and immune systems are stimulated and the small intestine is attacked and weakened.

In celiac disease the immune system in the small intestine wrongly targets the villi. These get inflamed and affected, and may disappear. The small intestine can no longer effectively consume any nutrients. This can lead to complications and health risks.

Individuals with a greater chance of developing celiac disease include those with:

  • another autoimmune disease, such as type 1 diabetes, rheumatoid arthritis, or an autoimmune disease that affects the thyroid or the liver
  • a genetic disorder, such as Down syndrome or Turner syndrome
  • a family member who has the disease

Having a member of the family with celiac disease raises a person’s chances of getting it to 1 in 10.

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