Celiac disease is
an autoimmune condition where the immune system reacts to gluten, sometimes
causing damage to the small intestine. Gluten is a protein found in foods
containing wheat, barley or rye.
If you have celiac
disease, eating gluten triggers an immune response to the gluten protein in
your small intestine. Over time, this reaction can damage your small
intestine's lining and prevent it from absorbing nutrients. This condition is
called malabsorption.
The intestinal
damage often causes symptoms such as diarrhea, fatigue, weight loss, bloating
or anemia. It also can lead to serious complications if it is not managed or
treated. In children, malabsorption can affect growth and development in
addition to gastrointestinal symptoms.
There's no definite
cure for celiac disease. But for most people, following a strict gluten-free
diet can help manage symptoms and help the intestines heal.
Symptoms
The symptoms of
celiac disease can vary greatly.
Diarrhea.
Fatigue.
Weight loss.
Bloating and gas.
Belly pain.
Nausea and vomiting.
Constipation.
However, more than
half the adults with celiac disease have symptoms that are not related to the
digestive system, including:
Anemia,
usually from iron deficiency due to decreased iron absorption.
Loss of
bone density, called osteoporosis, or softening of bones, called osteomalacia.
Itchy,
blistery skin rash, called dermatitis herpetiformis.
Mouth
ulcers.
Headaches
and fatigue.
Nervous
system injury, including numbness and tingling in the feet and hands, possible
problems with balance, and cognitive impairment.
Joint pain.
Reduced
functioning of the spleen, known as hyposplenism.
Elevated
liver enzymes.
Children
Children with
celiac disease are more likely than adults to have digestive problems,
including:
Nausea and
vomiting.
Chronic
diarrhea.
Swollen
belly.
Constipation.
Gas.
Pale,
foul-smelling stools.
Not being able to
absorb nutrients may cause:
Failure
to thrive for infants.
Damage to
tooth enamel.
Weight
loss.
Anemia.
Irritability.
Short
stature.
Puberty.
Neurological
symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning
disabilities, headaches, lack of muscle coordination and seizures.
Dermatitis herpetiformis
Gluten intolerance
can cause this blistery skin disease. The rash usually happens on the elbows,
knees, torso, scalp or buttocks. Like celiac disease, this condition is often
associated with changes to the lining of the small intestine. However, dermatitis
herpetiformis might not cause digestive symptoms.
Healthcare
professionals treat dermatitis herpetiformis with a gluten-free diet or
medicine, or both, to control the rash.
Causes
A person's genes,
combined with eating foods with gluten and other factors, can contribute to
celiac disease. However, the precise cause isn't known. Infant-feeding
practices, gastrointestinal infections and gut bacteria may contribute, but
these causes have not been proved. Sometimes celiac disease becomes active
after surgery, pregnancy, childbirth, viral infection or severe emotional
stress.
When the body's
immune system overreacts to gluten in food, the reaction damages the tiny,
hairlike projections, called villi, that line the small intestine. Villi absorb
vitamins, minerals and other nutrients from the food you eat. If your villi are
damaged, you can't get enough nutrients, no matter how much you eat.
Risk factors
A family member
with celiac disease or dermatitis herpetiformis.
Type 1 diabetes.
Down syndrome, Williams syndrome or Turner
syndrome.
Autoimmune thyroid disease.
Microscopic colitis.
Addison's disease.
Complications
Malnutrition. This happens if your small intestine can't absorb enough
nutrients. Malnutrition can lead to anemia and weight loss. In children,
malnutrition can cause slow growth and short stature.
Bone weakening. In children,
malabsorption of calcium and vitamin D can lead to a softening of the bone,
called osteomalacia or rickets. In adults, it can lead to a loss of bone
density, called osteopenia or osteoporosis.
Infertility and miscarriage. Not being
able to absorb calcium and vitamin D properly can contribute to reproductive
issues.
Lactose intolerance. Damage to
your small intestine might cause you belly pain and diarrhea after eating or
drinking dairy products that contain lactose. Once your intestine has healed,
you might be able to tolerate dairy products again.
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.
Nervous system conditions. Some people
with celiac disease can develop conditions such as seizures or a disease of the
nerves to the hands and feet, called peripheral neuropathy.
Nonresponsive celiac disease
Some people with
celiac disease don't respond to what they consider to be a gluten-free diet.
Nonresponsive celiac disease is often due to contamination of the diet with
gluten. Working with a dietitian can help you learn how to avoid all gluten.
People with
nonresponsive celiac disease might have:
Bacterial overgrowth in the small
intestine.
Microscopic colitis.
Poor pancreas function, known as
pancreatic insufficiency.
Irritable bowel syndrome.
Difficulty digesting sugar found in
dairy products (lactose), table sugar (sucrose), or a type of sugar found in
honey and fruits (fructose).
Truly refractory celiac disease that
is not responding to a gluten-free diet.
Refractory celiac disease
In rare instances,
the intestinal injury of celiac disease doesn't respond to a strict gluten-free
diet. This is known as refractory celiac disease. If you still have symptoms
after following a gluten-free diet for 6 months to 1 year, you should talk to your
healthcare team to see if you need further testing to look for explanations for
your symptoms
Two blood tests can help diagnose it:
Serology testing looks for
antibodies in your blood. Elevated levels of certain antibody proteins indicate
an immune reaction to gluten.
Genetic testing for human
leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out celiac
disease.
It's important to
be tested for celiac disease before trying a gluten-free diet. Eliminating
gluten from your diet might make the results of blood tests appear in the
standard range.
If the results of
these tests indicate celiac disease, one of the following tests will likely be
ordered:
Endoscopy. An endoscopy
uses a tiny camera on the end of a flexible tube to visually examine the upper
digestive system. The camera enables the health professional to view your small
intestine and take a small tissue sample, called a biopsy, to analyze for damage
to the villi.
Capsule endoscopy. This test
uses a tiny wireless camera to take pictures of your entire small intestine.
The camera sits inside a vitamin-sized capsule, which you swallow. As the
capsule travels through your digestive tract, the camera takes thousands of
pictures that are transmitted to a recorder. This test is used in some
situations where an exam of the entire or end of the small intestine is
desired.
If you might have
dermatitis herpetiformis, your healthcare professional may take a small sample
of skin tissue to examine under a microscope.
If you're diagnosed
with celiac disease, additional testing may be recommended to check your
nutritional status. This includes levels of vitamins A, B-12, D and E, as well
as mineral levels, hemoglobin and liver enzymes. Your bone health also may be
checked with a bone density scan.
Treatment
A strict, lifelong
gluten-free diet is the only way to manage celiac disease. Besides wheat, foods
that contain gluten include:
Barley.
Bulgur.
Durum.
Farina.
Graham
flour.
Malt.
Rye.
Semolina.
Spelt (a
form of wheat).
Triticale.
A dietitian who
works with people with celiac disease can help you plan a healthy gluten-free
diet. Even trace amounts of gluten in your diet can be damaging, even if they
don't cause symptoms.
Gluten can be
hidden in foods, medicines and nonfood products, including:
Modified food starch, preservatives
and food stabilizers.
Prescription and over-the-counter
medicines.
Vitamin and mineral supplements.
Herbal and nutritional supplements.
Lipstick products.
Toothpaste and mouthwash.
Communion wafers.
Envelope and stamp glue.
Play dough.
Certain makeup products.
Removing gluten
from your diet will typically reduce inflammation in your small intestine,
causing you to feel better and eventually heal. Children tend to heal more
quickly than adults.
Vitamin and mineral supplements
If your anemia or
nutritional deficiencies are severe, supplements may be recommended, including:
Copper.
Folic acid.
Iron.
Vitamin B-12.
Vitamin D.
Vitamin K.
Zinc.
Vitamins and
supplements are usually taken in pill form. If your digestive tract has trouble
absorbing vitamins, you might be able to get them by injection.
Follow-up care
Medical follow
