Celiac disease

Celiac disease is a medical condition that affects the inner lining of the small intestine. The small intestine is a long duct that extends from the stomach to the large intestine in our abdomen, and it is the part of the digestive tract where absorption of nutrients occurs.

The inner lining of the small intestine is covered by numerous finger-like projections that increase the absorptive area of the intestine. These projections are called villi. Villi are covered by microvilli that give the small intestine a velvety appearance.

In celiac disease, the destruction of villi is reported due to an immune response caused by the protein gluten, which is present in many foods1.

For instance, gluten is naturally present in barley, rye, wheat, and oats. When gluten comes in contact with villi, an immune response is triggered, which leads to unwanted inflammation, and ultimately destruction of the villi.

As a result, the absorptive area of the small intestine is significantly reduced.

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Celiac Disease
Symptoms of celiac disease:

Celiac disease mainly affects the intestine and digestive system. It causes symptoms in children and adults.

Common symptoms3 experienced by children in celiac disease include:

  • Weight loss
  • Persistent diarrhea
  • Pale, fatty stools with a foul smell
  • Vomiting
  • Abdominal pain

In adults, celiac disease causes the above symptoms, and also can affect other body systems in addition to the digestive tract. Common symptoms experienced by adults involve:

  • Fatigue
  • Seizures
  • Tingling and numbness of hands and feet
  • Iron deficiency anemia
  • Joint pain and stiffness
  • Tooth discoloration and enamel loss
  • Irregular menstrual periods

The symptoms of celiac disease may vary from person to person depending upon the extent of damage to the small intestine and the amount of gluten someone eats.

Some patients with celiac disease may have no symptoms if they absorb sufficient nutrients to maintain optimum health.

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Diagnosis:

Celiac disease is diagnosed on the basis of medical history and blood tests. Your provider will particularly be interested in gathering information on your symptoms and family history.

Blood studies will be performed including antibody tests and possibly genetic testing. In antibody testing, the levels of IgA, IgG, and tissue transglutaminase (t TG) are assessed. Genetic tests involve HLA DQ2 and HLA DQ84.

An endoscopy study with biopsy of the small intestine is needed to confirm the diagnosis. This test can be arranged as a quick and easy outpatient same day procedure at our Advanced Surgical Center, or in certain cases, at the hospital with one of our providers.

Treatment of celiac disease:

Treatment of celiac disease is very straightforward. Celiac disease is treated by eliminating gluten from the diet5.

Wheat and wheat products, rye, barley, and oats are the primary culprits that cause celiac disease. Patients with celiac disease must be extra viligant about avoiding gluten. Wheat is part of most diets throughout the world, so it can be difficult to avoid at times. It is always best to plan ahead when traveling for this reason.

When shopping, patients should be able to understand the ingredient labels of foods to assess for the presence of gluten.      Fortunately, in the US, it is becoming easier to live a gluten-free

lifestyle. Many manufacturers now sell gluten-free bread, pasta, and other dietary products. Many restaurants now also include gluten-free sections on their menus.

Your provider might also recommend a dietician to help guide your dietary plan so that you can get adequate nutrients while avoiding gluten.

Avoiding gluten is an effective treatment for celiac disease. It allows the intestinal villi to heal and regrow, and the absorption of nutrients can return to normal within days given strict adherence to a diet plan.

Complications:

Celiac disease can lead to several complications if left untreated, such as:

  • Osteoporosis
  • Vitamin and mineral deficiencies
  • Stunted growth in children
  • Cancer of the intestine

The bottom line:

Celiac disease is caused by an abnormal immune response to gluten in the diet. It damages intestinal villi decreasing the absorptive efficiency of the small intestine. It can cause nutritional deficiencies if not appropriately managed.

Avoidance of gluten is an effective treatment of the disease.

References:

  1. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018 Jan 6;391(10115):70–81.
  2. Pixabay.com. Available from: https://pixabay.com/illustrations/offal-marking-medical-colon-liver-1463369/
  3. Rubin JE, Crowe SE. Celiac Disease. Ann Intern Med. 2020 Jan 7;172(1):ITC1–16.
  4. Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021 Jan;160(1):63–75.
  5. Gujral N, Freeman HJ, Thomson ABR. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012 Nov 14;18(42):6036–59.
  6. Pixabay.com. Available from: https://pixabay.com/photos/breads-cereals-oats-barley-wheat-1417868/

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