3. Celiac disease is a
condition that damages
the lining of the small
intestine and prevents it
from absorbing parts of
food that are important
for staying healthy. The
damage is due to a
reaction to eating
gluten, which is found in
wheat, barley, rye, and
possibly oats.
4. Causes, incidence, and risk factors
The exact cause of celiac disease is unknown. The lining of
the intestines contains areas called villi, which help absorb
nutrients. When people with celiac disease eat foods or
use products that contain gluten, their immune system
reacts by damaging these villi.
This damage affects the ability to absorb nutrients
properly. A person becomes malnourished, no matter how
much food he or she eats.
The disease can develop at any point in life, from infancy
to late adulthood.
People who have a family member with celiac disease are
at greater risk for developing the disease. The disorder is
most common in Caucasians and persons of European
ancestry. Women are affected more often than men.
5. Figure 1: Healthy villi of Figure 3: Villi completely
Figure 2: Damaged villi of the
the small intestine seen destroyed by the immune
small intestine.
under the microscope. system.
6. People with celiac disease are more likely to have:
Autoimmune disorders such as
rheumatoid arthritis,
systemic lupus erythematosus
Jorgen syndrome
Addison's disease
Down syndrome
Intestinal cancer
Intestinal lymphoma
Lactose intolerance
Thyroid disease
Type 1 diabetes
7. Symptoms
The symptoms of celiac disease can be different from person to
person. This is part of the reason why the diagnosis is not always
made right away. For example, one person may have constipation, a
second may have diarrhea, and a third may have no problem with
stools.
Gastrointestinal symptoms include:
Abdominal pain, bloating, gas, or indigestion
Constipation
Decreased appetite (may also be increased or unchanged)
Diarrhea, either constant or off and on
Lactose intolerance (common when the person is diagnosed, usually
goes away after treatment)
Nausea and vomiting
Stools that float, are foul smelling, bloody, or “fatty”
Unexplained weight loss (although people can be overweight or of
normal weight)
8. Because the intestines do not absorb many important
vitamins, minerals, and other parts of food, the following
symptoms may start over time:
Bruising easily
Depression or anxiety
Fatigue
Growth delay in children
Hair loss
Itchy skin (dermatitis herpetiformis)
Missed menstrual periods
Mouth ulcers
Muscle cramps and joint pain
Nosebleeds
Seizures
Tingling or numbness in the hands or feet
Unexplained short height
9.
10. Children with celiac disease may have:
Defects in the tooth enamel and changes in tooth color
Delayed puberty
Diarrhea, constipation, fatty or foul-smelling stools, nausea,
or vomiting
Irritable and fussy behavior
Poor weight gain
Slowed growth and shorter than normal height for their age
11. Signs and tests
Albumin (may be low)
Alkaline phosphates (high level may be a sign of bone loss)
Clotting factor abnormalities
Cholesterol (may be low)
Complete blood count (CBC - test for anemia)
Liver enzymes (transaminases)
Prothrombin time
Blood tests can detect several special antibodies, called ant tissue transglutaminase
antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will
order these antibody tests if celiac disease is suspected.
If the tests are positive, upper endoscopy is usually performed to sample a piece of
tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may
show a flattening of the villi in the parts of the intestine below the duodenum.
Genetic testing of the blood is also available to help determine who may be at risk for
celiac disease.
A follow-up biopsy or blood test may be ordered several months after the diagnosis
and treatment. These tests evaluate your response to treatment. Normal results mean
that you have responded to treatment, which confirms the diagnosis. However, this
does not mean that the disease has been cured.
12. TREATMENT
Celiac disease cannot be cured. However, your symptoms will go away and the villi in
the lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat
foods, beverages, and medications that contain wheat, barley, rye, and possibly oats.
You must read food and medication labels carefully to look for hidden sources of these
grains and ingredients related to them. Because wheat and barley grains are common
in the American diet, sticking with this diet is challenging. With education and
planning, you will heal.
You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet
will affect testing for the disease.
The health care provider may prescribe vitamin and mineral supplements to correct
nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be
prescribed for short-term use or if you have sprue that does not respond to treatment.
Following a well-balanced, gluten-free diet is generally the only treatment you need to
stay well.
When you are diagnosed, get help from a registered dietitian who specializes in celiac
disease and the gluten-free diet. A support group may also help you cope with the
disease and diet.
13.
14. Expectations (prognosis)
Following a gluten-free diet heals the damage to the intestines and prevents further damage.
This healing most often occurs within 3 - 6 months in children, but it may take 2 - 3 years in
adults.
Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is
made.
Some problems caused by celiac disease may not improve, such as a shorter than expected
height and damage to the teeth.
Complications
You must carefully continue to follow the gluten-free diet. When untreated, the disease can
cause life-threatening complications.
Delaying diagnosis or not following the diet puts you at risk for related conditions such as:
Autoimmune disorders
Bone disease (osteoporosis, kyphoscoliosis, fractures)
Certain types of intestinal cancer
Low blood count (anemia)
Low blood sugar (hypoglycemia)
Infertility or repeated miscarriage
Liver disease
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