Celiac Disease

Overview

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley, and rye. When a person with celiac disease consumes gluten, their small intestine's lining is damaged, leading to malabsorption of nutrients, which can cause symptoms such as diarrhea, fatigue, weight loss, bloating, and anemia. This immune reaction can occur in both children and adults, with symptoms varying between the two age groups. The primary treatment for celiac disease is maintaining a strict gluten-free diet, which helps manage symptoms and promotes intestinal healing.

Understanding the disease

Symptoms

The symptoms of celiac disease can vary greatly and differ in children and adults. For adults, digestive symptoms may include diarrhea, fatigue, weight loss, bloating, gas, abdominal pain, nausea, vomiting, and constipation. However, more than half of adults with celiac disease have signs and symptoms unrelated to the digestive system, such as anemia, loss of bone density, itchy skin rash, mouth ulcers, headaches, nervous system injury, joint pain, and reduced spleen function. Children with celiac disease are more likely to have digestive problems like nausea, vomiting, chronic diarrhea, abdominal swelling, constipation, and pale, foul-smelling stools. If left untreated, celiac disease can lead to serious complications, including malnutrition, anemia, and intestinal lymphoma.

Risk Factors

The risk factors for developing celiac disease include:

1. Having a family member with celiac disease or dermatitis herpetiformis
2. Having Type 1 diabetes
3. Having Down syndrome or Turner syndrome
4. Having autoimmune thyroid disease
5. Having microscopic colitis (lymphocytic or collagenous colitis)
6. Having Addison's disease
7. Having cancer People with celiac disease who don't maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer. It's important to note that having one or more of these risk factors doesn't necessarily mean a person will develop celiac disease, but it may increase their likelihood of doing so.

Development

Celiac disease develops when the body's immune system overreacts to gluten, a protein found in wheat, barley, and rye. This reaction damages the tiny, hairlike projections (villi) that line the small intestine, which are responsible for absorbing vitamins, minerals, and other nutrients from food. The precise cause of celiac disease isn't known, but it may be related to genetic factors, infant-feeding practices, gastrointestinal infections, gut bacteria, and certain life events such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Assessment and Diagnosis

Triage

You should consult a doctor if you or your child is experiencing symptoms of celiac disease, such as diarrhea, fatigue, weight loss, bloating, anemia, or if you have unexplained digestive discomfort that lasts for more than two weeks. It's important to seek medical advice before starting a gluten-free diet, as this can affect the test results for celiac disease. If someone in your family has celiac disease or related conditions, discuss with your doctor whether you should be tested for celiac disease.

Diagnosis

To diagnose celiac disease, blood tests are commonly used to detect the presence of antibodies in the blood, which indicate an immune reaction to gluten. Serology testing looks for elevated levels of specific antibody proteins, while genetic testing can help rule out celiac disease by identifying the presence of human leukocyte antigens (HLA-DQ2 and HLA-DQ8). If blood tests suggest celiac disease, further tests such as an endoscopy or capsule endoscopy may be ordered to analyze the small intestine for damage to the villi. In some cases, a skin biopsy may be performed if dermatitis herpetiformis is suspected. A strict, lifelong gluten-free diet is the only way to manage celiac disease.

Management and Treatment

Complications

Potential complications of celiac disease include an increased risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer, nervous system problems such as seizures or peripheral neuropathy, nonresponsive celiac disease, bacterial overgrowth, microscopic colitis, poor pancreas function, irritable bowl syndrome, difficulty digesting sugars in dairy products, table sugars, or fructose, and refractory celiac disease. Additionally, celiac disease can lead to a variety of other complications such as anemia, osteoporosis, and dermatitis herpetiformis, among others.

Home Remedies

It is important to consult a healthcare professional for proper diagnosis and treatment of celiac disease. Following a strict gluten-free diet and managing any symptoms with their guidance is the recommended approach.

Treatment

For most people with celiac disease, the primary treatment is following a strict gluten-free diet. This can help manage symptoms and promote intestinal healing. A gluten-free diet involves avoiding foods containing wheat, barley, and rye, as well as any products that may be contaminated with gluten. In some cases, medications may be prescribed to manage specific symptoms or complications, such as anti-inflammatory drugs for pain relief, iron supplements for anemia, or calcium and vitamin D supplements for bone health. It's important to consult a healthcare professional before starting a gluten-free diet, especially if you're planning to be tested for celiac disease. In addition, working closely with a registered dietitian who specializes in gluten-free diets can help ensure that you receive proper nutrition while managing the condition.

Preparing for medical consultation

To prepare for an appointment for celiac disease, you should:

1. Continue eating a normal diet until your appointment, as cutting gluten before the test can affect the results.
2. Make a list of your symptoms, including when they started and whether they've changed over time, as well as key personal information, such as family medical history and recent life changes.
3. Bring a list of all medications, vitamins, or supplements you take, including doses.
4. Ask your doctor about any pre-appointment restrictions, such as fasting before specific tests.
5. Prepare a list of questions to ask your doctor, such as:

• What's the most likely cause of my symptoms?
• Is my condition temporary or long-term?
• What tests do I need?
• What treatments can help?
• Do I need to follow a gluten-free diet? Remember to bring a family member or friend to the appointment for support and to help remember important details.