Understanding Celiac Disease

Left untreated, celiac disease can lead to a number of other disorders.

What Is Celiac Disease

Celiac disease (also known as celiac sprue or gluten intolerance) is a digestive disorder that damages the small intestine. This damage interferes with the absorption of nutrients from food. People with celiac disease cannot tolerate gluten. Gluten is a protein found mainly in wheat, rye, and barley. It is also found in everyday products such as medicines, vitamins, and lip balms.

When a person with celiac disease eats gluten, the immune system responds by attacking the lining of the small intestine and destroying villi. Villi are tiny fingerlike protrusions lining the small intestine. Villi allow nutrients from food to be absorbed through the walls of the intestine and into the bloodstream. Table 1^1-4 highlights celiac disease statistics.

The Symptoms

The symptoms of celiac disease vary according to the age of the individual (Table 2).⁴ Most people have 1 or more symptoms. Chronic diarrhea is common, with up to 85% of patients experiencing chronic diarrhea.³ Some people with celiac disease have no symptoms, but they can still develop complications from the disease over time. A person can have gluten sensitivity without the immune system attacking the small intestine. Symptoms of gluten sensitivity are generally milder than those seen in celiac disease, but the symptoms of gluten sensitivity improve with a gluten-free or gluten-restricted diet.²

Celiac disease is a serious disorder. Untreated, celiac disease can lead to a number of other disorders, including weight loss, anemia, osteoporosis, infertility/ miscarriage, lactose intolerance, vitamin and mineral deficiencies, nervous system disorders, pancreatic disorders, cancer, diabetes, thyroid disease, liver disease, rheumatoid arthritis, and damage to the glands that produce hormones, tears, and saliva.^1,4,5 Complications from celiac disease generally occur years after diagnosis.

Diagnosis

Early diagnosis of celiac disease is critical and may prevent complications later in life. Many symptoms of celiac disease are also associated with other intestinal disorders. Diagnosis is a 2-step process. First, a blood sample is tested for celiac disease. If the blood test is positive for celiac disease, a small biopsy sample is taken from the small intestine. To obtain a piece of the small intestine, a long, thin tube is inserted through the patient’s mouth and stomach and into the small intestine. A confirmed diagnosis is made when the blood test and the biopsy results are positive, and then a gluten-free diet alleviates symptoms.^1,5

Treatment

Following a strict gluten-free diet is the only treatment for celiac disease. Even eating a tiny amount of gluten can damage the villi of the small intestine. This means giving up some of your favorite foods for life. A gluten-free diet helps reverse the damage caused by celiac disease.^5,6 Complete avoidance of gluten is difficult for patients to achieve and maintain. Flour, for example, is found in hundreds of products. With strict discipline, many people are able to achieve a glutenfree diet. A small percentage of patients with celiac disease fail to respond to a gluten-free diet. In these instances, prescription drugs may be used to treat some of the symptoms.³ Table 3^1,3,5,7,8 highlights recommendations for achieving a gluten-free diet.

Final Thought

Consider joining a support group to learn how others have coped with celiac disease and to exchange recipes. The Celiac Disease Foundation (http://celiac .org/chapters) lists support groups located in each state.

Dr. Zanni is a psychologist and healthsystem consultant based in Alexandria, Virginia.

References:

• Celiac disease facts and figures. The University of Chicago Disease Center website. www.cureceliacdisease.org/wp-content/uploads/2011/09/CDCFactSheets8_FactsFigures.pdf. Accessed May 21, 2014.
• What is celiac disease? National Foundation for Celiac Awareness website. www.celiaccentral.org/SiteData/docs/whatisceli/9f4e6c96876aa99c/what%20is%20celiac%20disease%20-%2011-22-2013.pdf. Accessed May 21, 2014.
• Goebel S. Celiac sprue. Medscape website. http://emedicine.medscape.com/article/171805-overview. Accessed May 15, 2014.
• Celiac disease. National Digestive Diseases Information Clearinghouse website. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/. Accessed May 18, 2014.
• Celiac disease. FamilyDoctor.org website. http://familydoctor.org/familydoctor/en/diseases-conditions/celiac-disease.printerview.all.html. Accessed May 18, 2014.
• What I need to know about celiac disease. National Digestive Diseases Information Clearinghouse website. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac_ez/. Accessed May 21, 2014.
• Treatment of celiac disease and gluten-related disorders, gluten-free lifestyle. Celiac Support Association website. www.csaceliacs.info/treatment_of_celiac_disease.jsp. Accessed May 18, 2014.
• Celiac disease: nutritional considerations. MedlinePlus Medical Encyclopedia website. www.nlm.nih.gov/medlineplus/ency/article/002443.htm. Accessed May 18, 2014.