Celiac disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 25, 2016
StartDiseasesCeliac disease

Celiac disease, also known as gluten-sensitive enteropathy or celiac sprue, is an inherited autoimmune disease that affects people of all ages. Individuals with this condition are unable to eat grains without triggering a reaction that prevents the small intestine from absorbing the nutrients it needs.

Celiac disease may affect as many as one in every 100 people around the world, causing significant health risks to those who have not been diagnosed. People who have siblings, children or parents with celiac disease have a ten percent chance of developing celiac disease themselves.

Contents

Definition & Facts

Celiac disease is a chronic condition in which the ingestion of gluten, a protein found in barley, wheat and rye, creates an immune reaction damaging the intestinal wall of genetically prone individuals. When these people consume gluten, their immune systems attack the small finger-shaped projections, or villi on the intestinal wall, injuring the gut and causing malnutrition. According to the Center for Disease Control, as many as two and one-half million people in the United States may have celiac disease and not know it.

Symptoms & Complaints

Although celiac disease is associated with as many as 300 known symptoms, the condition can be symptomless, making it hard to diagnose. In children, digestive issues are the most common sign of the illness. Other symptoms include the following:

Digestive problems are less common in adults with celiac disease than they are in children who have the disorder. Approximately half of all adults with celiac disease experience weight loss, and one-third suffer from diarrhea. Twenty percent of adults have constipation, and another ten percent are obese. In adults, the following symptoms are common:

Causes

Over the past 50 years, incidences of celiac disease have increased by 400 percent, but its cause is still a mystery. Scientists know that certain genetic mutations increase the likelihood of a person having celiac disease, but not everyone with those mutations develops the disorder.

Celiac disease is widespread in the North America, South America, Europe, Australia, the Middle East, and South Asia. It is rarely seen in other parts of Asia or south of the Sahara in Africa. Researchers know that stress, pregnancy, and other illnesses can trigger celiac disease. They also know it occurs more frequently in people with certain illnesses:

Studies released in 2015 by a team of scientists from McMaster’s Farncombe Family Digestive Health Research Institute in Ontario, Canada, say that celiac disease is caused by specific gut bacteria that triggers a negative response to gluten. This may explain why less than five percent of the people who carry the related genetic mutation actually develop the disorder.

Diagnosis & Tests

There is no clear-cut test for the diagnosis of celiac disease. Doctors usually begin with a health history and physical examination to determine the severity of symptoms and its effect on the body. A variety of laboratory tests, sometimes called the celiac disease comprehensive cascade helps to make an initial diagnosis and identifies candidates for intestinal biopsies. Tests, such as those for lactose intolerance, measure absorption of nutrients by the intestines.

Genetic testing may also be done, but it can only rule out the possibility of developing the illness and detect family members susceptible to the disease. One of the problems with current tests is that they require a month of eating gluten-containing foods in order to test their effect on the stomach.

Researchers at the University of Australia are not only developing a blood test that could find celiac disease before it damages the intestine; the results can be found within 24 hours. Researchers say the test can pinpoint celiac disease with an accuracy rate of 85 to 94 percent and rule it out with 100 percent certainty in others.

Treatment & Therapy

Celiac disease is a chronic condition with no cure. The only successful treatment is rigorous adherence to a gluten-free diet. Because the disease is so complex, novel options for treatment are not expected in the near future. Some people may be able to substitute uncontaminated oats for grains, but even that is a process of trial and error. Processed foods that may contain gluten include salad dressings, canned soups, candy bars, instant coffee, yogurt, ice cream, pasta, processed meats, and ketchup and mustard. Wheat starch is often used in the production of capsules and tablets, and gluten may also be found in vitamin supplements and cosmetics.

Beer should be avoided, but moderate consumption of brandy, whiskey, wine and other alcohols is acceptable. Removal of dairy products may be recommended until symptoms of celiac disease are under control. Doctors may suggest supplements if malnutrition is a problem. Gluten-free foods include the following: rice, corn, buckwheat, potatoes, products made with tapioca or soybean flours, meat or poultry, fresh fish, vegetables without sauces, and natural yogurt and cheeses.

Prevention & Prophylaxis

There is no known way to prevent celiac disease. A person who already has celiac disease can prevent further damage to the immune system by eating a gluten free diet. Because some adults with the condition have spleens that do not function efficiently, doctors may recommend vaccines for the prevention of pneumonia.

Past research suggests giving babies small amounts of gluten at a young age, preferably while they were being breastfed, to prevent celiac disease. More studies are needed to test that hypothesis. Researchers have not determined whether feeding practices during infancy prevent celiac disease later in life or whether they delay its onset.