Celiac Disease : Causes, Symptoms, Treatments
Synopsis: Celiac disease is a disorder which causes problems with a persons intestines when they consume gluten. Dr. Murray says the study findings highlight the need for increased awareness of celiac disease, both among physicians and patients. Part of the problem is that celiac disease symptoms are variable and can be mistaken for other diseases that are more common, such as irritable bowel syndrome.
Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. Symptoms include pain and discomfort in the digestive tract, chronic constipation and diarrhea, failure to thrive (in children), anaemia and fatigue, but these may be absent, and symptoms in other organ systems have been described.
Celiac disease is:
- Characterized by damage to the mucosal lining of the small intestine; known as villous atrophy
- Responsible for the malabsorption of nutrients resulting in malnutrition
- Linked to genetically transmitted Histocompatibility cell antigens
- Linked to skin blisters known as dermatitis herpetiformis
- Not age-dependent; it can become active at any age
- Common; about one in 133 have it
- A genetic, inheritable disease
'Gluten,' is a generic term used to describe storage proteins that are found in grains. Each form of protein is slightly different from the others. Gluten in rye, barley, wheat, and in lower amounts - oats, have particular amino acid sequences which are harmful to people who have celiac disease. The damaging proteins are rich in glutamine and proline. Persons with celiac disease find that as peptides, some as 33-MER, cannot be broken down any further and emulate T-cells to produce antibodies. The antibodies attack villi in the person's small intestine and reduce their ability to absorb nutrients.
Here is a list of gluten free products Disabled World has compiled.
Celiac disease is not a form of communicable disease - you cannot, 'catch,' celiac disease. Instead, the potential for the disease may be present in the person's body from birth. The onset of the disease is something that is not confined to a particular gender or age range, although there are more women than men who are diagnosed with celiac disease. While medical science does not know exactly what activates the disease, there are three things that are required for a person to develop celiac disease; these include:
- A trigger - some environmental, emotional or physical event in one's life
- A diet containing Wheat, Barley, Rice, Oats, or any of their derivatives
- A genetic disposition
As a genetic disease, celiac disease runs in families. People inherit the tendency to get the disease from their parents. If one member of the family has the disease, approximately one out of ten additional members of their family is likely to have it as well. People may have the tendency towards celiac disease for a period of time without experiencing any symptoms before they actually become ill. Things such as a physical injury, stress, giving birth to a child, surgery, or an infection can trigger celiac disease in persons who have a tendency for the disease.
Damage to the person's small intestine, caused by celiac disease, is both insidious and slow to develop. The damage is:
- In most cases Reversible to completely normal bowel function if the injurious protein is excluded from the diet
- Probably produced by the cellular immune system when gluten-type prolamins are present
- Associated with antibodies to gliadin, reticulin and/or endomysial proteins
- Almost certainly mediated by the immune system
- Most likely not directly caused by the antibodies
Adults who become sick with celiac disease may experience a general feeling of poor health accompanied with irritability, depression, and fatigue - despite having few intestinal problems. Osteoporosis is a serious illness that can occur due to loss of calcium from the person's diet. One symptom of osteoporosis can be nighttime bone pain. Five-percent of persons with celiac disease also experience anemia.
Infants with celiac disease can experience diarrhea and abdominal pain, or even bloody diarrhea. They can fail to grow or gain weight. Young children can experience abdominal pain accompanied with a loss of appetite and nausea, as well as anemia, mouth sores, and allergic dermatitis. Children can be fretful, irritable, excessively dependent, or emotionally withdrawn. As the disease worsens, children may experience undernourishment and may or may not have diarrhea and vomiting. A child may have an enlarged stomach, flat buttocks and thin thigh muscles. Adolescents might reach puberty late and be short. Celiac disease can cause hair loss and dermatitis herpetiformis.
Testing for celiac disease is ordered when a person experiences symptoms that suggest the disease. These symptoms can include malabsorption, diarrhea, weakness, fatigue, abdominal pain, joint pain, and weight loss. Testing could be ordered as a part of an investigation of osteoporosis, seizures, anemia, or infertility. In children, testing for celiac disease could be ordered if the child has presented symptoms such as delayed movement, gastrointestinal symptoms, failure to thrive, or short stature.
Testing of a person's auto-antibody levels should initially be ordered while they still have gluten in their diet. Indeterminate or positive results can then be determined through a biopsy. Antibody testing can be ordered when the person has been on a gluten-free diet over a period of time; something that is done to verify their antibody levels have decreased, as well as to verify that the diet has been effective in relieving their symptoms and reversing intestinal lining damage. If the person's symptoms have not been relieved, testing may be ordered to check for their compliance with the diet, and to help a doctor and the person to look for hidden gluten in the person's diet or additional reasons for a lack of relief. Persons who do not present symptoms of celiac disease, but have a relative with it, are not recommended for testing as a screen of the general population.
Chances are you have celiac disease if your symptoms disappear when you follow a strictly gluten-free diet, or if you have dermatitis herpetiformis. Blood testing can also assist a doctor in making a diagnosis of the disease. Blood testing must be done prior to pursuit of a gluten-free diet. A diagnosis of celiac disease can be confirmed through a biopsy of intestinal tissue.
Additional testing that a doctor can perform to assist in determining the severity of celiac disease, as well as the extent of the person's malabsorption, malnutrition, and the level of involvement of their other organs include:
- Comprehensive Metabolic Panel (CMP) to determine electrolyte, protein, and calcium levels, and verify the status of the kidney and liver
- Erythrocyte Sedimentation Rate (ESR) to evaluate inflammation
- Vitamin D, E, and B12 to measure vitamin deficiency
- C-Reactive Proteing (CRP) to evaluate inflammation
- Complete Blood Count (CBC) to look for anemia
- Stool fat, to help evaluate malabsorption
Where treating celiac disease is concerned the good news is that you can control the disease by simply not eating gluten.
While the disease is serious, following the right diet can reverse the damage caused by the disease.
Treatment for celiac disease does not involve either surgery or medications, it requires education of both yourself and your family.
Treatment of celiac disease requires cooperation with both your doctor and yourself - working together to remove gluten from your diet.
While celiac disease is fairly common - approximately one in one-hundred and thirty-three persons in America are affected by the disease; the majority of those who have celiac disease are unaware that they do have it. One of the reasons for this lack of awareness is that the symptoms of the disease may be either absent or mild, even when intestinal damage is present in tissue that has been biopsied. The symptoms of celiac disease are also similar to those of other diseases, causing a diagnosis of celiac disease to be either missed or delayed, sometimes for years.
You might expect to find gluten in products such as pasta, cookies, bread and other grain products; however, gluten is also found in a number of processed foods like soy sauce, frozen French fries, and rice cereals. Non-food items like household cleaners and cosmetics may contain gluten. The clinical gluten-free diet recommends elimination of gluten from cross-contamination or contact with gluten-containing items. Persons who are on a gluten-free diet have to take exceptional care during both food preparation and storage to avoid cross-contamination and contact with gluten-containing products.
Mayo Clinic study finds celiac disease 4 times more common than in 1950s
Celiac disease, an immune system reaction to gluten in the diet, is over four times more common today than it was 50 years ago, according to findings of a Mayo Clinic study published this month in the journal Gastroenterology.
The study also found that subjects who did not know they had celiac disease were nearly four times more likely than celiac-free subjects to have died during the 45 years of follow-up.
"Celiac disease has become much more common in the last 50 years, and we don't know why," says Joseph Murray, M.D., the Mayo Clinic gastroenterologist who led the study. "It now affects about one in a hundred people. We also have shown that undiagnosed or 'silent' celiac disease may have a significant impact on survival. The increasing prevalence, combined with the mortality impact, suggests celiac disease could be a significant public health issue."
In patients with celiac disease, the presence of a protein called gluten from wheat, barley or rye triggers an immune system attack, damaging the villi in the small intestine. Villi are finger-like projections that increase the intestine's surface area for nutrient absorption. Celiac disease symptoms may include diarrhea, abdominal discomfort, weight loss, anemia, unexplained infertility, loss of teeth or even premature or severe osteoporosis.
The Mayo Clinic research team tested blood samples gathered at Warren Air Force Base (AFB) in Wyoming between 1948 and 1954 for the antibody that people with celiac disease produce in reaction to gluten. They compared those blood test results with those from two recently collected sets from Olmsted County, Minn. One matched the ages of those from the 1948 testing at the time of the blood draw, and the other matched their birth years. Researchers found that young people today are 4.5 times more likely to have celiac disease than young people were in the 1950s, while those whose birth years matched the Warren AFB participants were four times more likely to have celiac disease.
"Celiac disease is unusual, but it's no longer rare," says Dr. Murray. "Something has changed in our environment to make it much more common. Until recently, the standard approach to finding celiac disease has been to wait for people to complain of symptoms and to come to the doctor for investigation. This study suggests that we may need to consider looking for celiac disease in the general population, more like we do in testing for cholesterol or blood pressure."
Dr. Murray says the study findings highlight the need for increased awareness of celiac disease, both among physicians and patients. "Part of the problem is that celiac disease symptoms are variable and can be mistaken for other diseases that are more common, such as irritable bowel syndrome," he says. "Some studies have suggested that for every person who has been diagnosed with celiac disease, there are likely 30 who have it but are not diagnosed. And given the nearly quadrupled mortality risk for silent celiac disease we have shown in our study, getting more patients and health professionals to consider the possibility of celiac disease is important."
Celiac Disease Facts and Statistics
- In the United States, gluten might not be listed on labels, because the US Food and Drug Administration (FDA) has historically classified gluten as GRAS (generally recognized as safe). In August 2013, FDA issued a final rule, effective August 2014, to define the term gluten-free for voluntary use in the labeling of foods i.e. presence of gluten in the food must be less than 20 parts per million.
- Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.
- Wheat allergy and coeliac disease are different disorders.
- The protein content of some pet foods may also be enhanced by adding gluten.
- Gluten is often present in beer and soy sauce, and can be used as a stabilizing agent in more unexpected food products, such as ice cream and ketchup.
- Gluten, when dried and milled to a powder and added to ordinary flour dough, improves a dough's ability to rise and increases the bread's structural stability and chewiness.
- Coeliac disease is an autoimmune disorder that affects the digestive process of the small intestine.
- Non-coeliac gluten sensitivity (sometimes known as gluten intolerance) is a condition thought to arise as a result of an immunological response to gluten that differs in nature to the immune response characteristic of coeliac disease.
- In the United States celiac disease (coeliac disease) is thought to affect between 1 in 1750 (defined as clinical disease including dermatitis herpetiformis with limited digestive tract symptoms) to 1 in 105 (defined by presence of IgA TG in blood donors).
- Globally celiac disease (coeliac disease) affects between 1 in 100 and 1 in 170 people - rates do however vary between different regions of the world from as few as 1 in 300 to as many as 1 in 40.
- Other populations at increased risk for celiac disease, with prevalence rates ranging from 5% to 10%, include individuals with Down and Turner syndromes, type 1 diabetes, and autoimmune thyroid disease, including both hyperthyroidism (over-active thyroid) and hypothyroidism (under-active thyroid).
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