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Celiac Disease

(Celiac disease should not be confused with Gluten Sensitivity. Read about Gluten Sensitivity here).

What is Celiac Disease?

Celiac disease (CD) is

… an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide.  Two and one-half million Americans are undiagnosed and are at risk for long-term health complications. [1]

When people who have CD consume a protein called gluten (typically found in wheat, rye, and barley), an immune response is initiated within the small intestine. This response results in an attack on microscopic fingerlike structures called villi. These villi are responsible for promoting nutrient absorption for the body. The resulting damage or destruction to these structures causes nutrients to be poorly absorbed. In CD all the components of the diet (carbohydrate, fats, minerals and vitamins) or only a single nutrient such as a mineral (calcium or iron) or a single vitamin such as folic acid may be malabsorbed.[2] Thus, the body’s ability to receive complete nutrition from food is severely compromised.

What Are The Symptoms Of Celiac Disease?

Because of the inflammatory nature of the disease the body may respond with generalized symptoms or the autoantibody response may result in other organ damage and symptoms. The Celiac Disease Center of Columbia University thus designates celiac disease as a multisystem disease with the possibility of every organ in the body being affected.[3]

Children with untreated celiac disease are at special risk. The lack of nutrient absorption can have severe negative effects on growth and development. These include: failure to thrive in infants, learning difficulties in school-age children, irritability and behavioral difficulties, delayed puberty, and short stature, as well as recurrent abdominal pain, constipation, and other GI symptoms.

While the primary clinical manifestation of CD in adults was thought to be diarrhea, this assumption now seems to be changing. Recent studies indicate the percentage of people exhibiting this symptom seems to be less than 50%.[4][5] Other common symptoms that have been associated with CD are iron deficient anemia, osteoporosis, reflux or dyspepsia, IBS, abnormalities of liver-function, recurrent miscarriages, migraines and thyroid disease. Other less typical symptoms are neurological manifestations, dermatitis herpetiformis, vitamin and mineral deficiencies, and increased risk of lymphoma.

Recent studies have found that the mean age at diagnosis for the adult CD patient is about 46 years old.[6] This means that these patients may have been exposed to a lifetime of poor nutrient absorption. The Celiac Disease Center at Columbia University lists an array of symptoms and complications associated with CD. They suggest that people with these symptoms be screened for CD. They also say that this list is not exhaustive.

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Celiac.org has an excellent list of other autoimmune diseases that are associated with CD. See here: http://celiac.org/celiac-disease/what-is-celiac-disease/.

Who should be tested for Celiac Disease?

Researchers now suggest that anyone with the above symptoms be tested for CD. Since there is a close association of CD with other related autoimmune disorders, it is recommended that individuals with these disorders be tested as well. Current studies have also shown that first-degree relatives of CD patients have a 5% – 10% chance of developing the disease. Physicians advise CD screening for parents, children and siblings of patients who have CD.

How To Diagnose Celiac Disease

The disease is confirmed through celiac panel blood tests, which include

  • Total IgA
  • IgA-tTG
  • IgA-EMA
  • If IgA is deficient, it is recommended that the IgG/IgA-DGP also be ordered. At the discretion of the doctor, IgG-AGA can also be ordered[7]

In order for these tests to be meaningful they must be performed while the person’s diet includes gluten. There are reports that the tests can show false negatives and a person can become positive after the initial testing.[8]

Genetic testing can also be performed to evaluate an at risk person’s ability to develop CD. These genes are located on the HLA-class II complex and are called DQ2 and DQ8. According to the University of Chicago Celiac Disease Center, “Each case of celiac disease has been found to show these so-called “haplotypes”; therefore, a negative gene test would mean that celiac disease couldn’t develop in that individual.” A positive gene test, however, does not diagnose the disease but increases the likelihood that it is present.

In the event that the clinical signs and blood tests suggest CD, the clinician can suggest that the patient undergo a small intestine biopsy. This is the so-called gold standard of CD diagnosis. This test will reveal if the villi have been damaged. Damaged villi are indicative of CD. However some people with CD can have a normal biopsy.

How Is Celiac Disease Treated?

At this time, most experts suggest that the only treatment for celiac disease is the commitment to a strict gluten-free lifestyle. This involves removing all wheat, barley, rye, and common oats from one’s diet. While there can be no intestinal healing without a gluten free diet, other factors should be considered. Since most CD patients are diagnosed at later ages after years of nutrition depletion has occurred, more attention is now being focused on vitamin supplements, diet considerations and lifestyle changes.

Footnotes

[1] http://celiac.org/celiac-disease/what-is-celiac-disease/

[2] http://celiacdiseasecenter.columbia.edu/celiac-disease/definition-and-clinical-manifestations

[3] Ibid.

[4] Ibid.

[5] https://ca.news.yahoo.com/celiac-disease-showing-many-forms-ages-230313570.html

[6] http://www.ncbi.nlm.nih.gov/pubmed/12741468

[7] http://www.celiaccentral.org/gettested/

[8] http://celiacdiseasecenter.columbia.edu/celiac-disease/definition-and-clinical-manifestations

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