More than 2-million Americans suffer from Celiac Disease, a digestive disorder that damages the small intestine and interferes with the absorption of nutrients in food. It’s no wonder that Celiac Disease has quickly become a commonly known genetic disorder.
Through diagnosis and dietary education, the Digestive Disease Center of the Hudson Valley, dedicates itself to helping people with Celiac feel better and improve their digestive health.
About Celiac Disease
People who have Celiac Disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medicines, vitamins and lip balms.
When people with Celiac Disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats.
Celiac Disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten. Celiac Disease is genetic, meaning it runs in families. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection or severe emotional stress.
Symptoms of Celiac Disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include:
- abdominal bloating and pain
- chronic diarrhea
- pale, foul-smelling, or fatty stool
- weight loss
Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty and dental enamel defects of the permanent teeth.
Adults are less likely to have digestive symptoms and may, instead, have one or more of the following:
- unexplained iron-deficiency anemia
- bone or joint pain
- bone loss or osteoporosis
- depression or anxiety
- tingling numbness in the hands and feet
- missed menstrual periods
- infertility or recurrent miscarriage
- canker sores inside the mouth
- an itchy skin rash called dermatitis herpetiformis
People with Celiac Disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition—which can lead to anemia, osteoporosis, and miscarriage, among other problems, such as liver disease and cancer of the intestine.
Symptoms also vary depending on a person’s age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications.
People with Celiac Disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between Celiac Disease and these diseases may be genetic. They include:
- type 1 diabetes
- autoimmune thyroid disease
- autoimmune liver disease
- rheumatoid arthritis
- Addison’s disease, a condition in which the glands that produce critical hormones are damaged
- Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed
Celiac Disease has a reputation for being misdiagnosed. This is because so many of its symptoms are similar to those of other diseases.
Celiac Disease can often be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections and chronic fatigue syndrome. However, diganosis rates are increasing as doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available.
The Blood Test
To diagnose Celiac Disease, physicians at the Digestive Disease Center will begin with a blood test that determines higher than normal levels of certain autoantibodies–proteins that react against the body’s own cells or tissues in the blood.
If test results are negative but Celiac Disease is still suspected, additional blood tests may be needed.
Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pasta. If a person stops eating foods with gluten before being tested, the results may be negative for Celiac Disease even if the disease is present.
If a blood test and symptoms point to Celiac Disease, physicians at the Digestive Disease Center will perform an Upper Endoscopy procedure in order to take a biopsy of the small intestine. This will confirm the diagnosis. During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi. During an Upper Endoscopy, the physician eases a long, thin tube called an endoscope through the patient’s mouth and stomach into the small intestine. The doctor then takes the tissue sample, using instruments passed through the endoscope.
Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with Celiac Disease. The rash usually occurs on the elbows, knees and buttocks. Most people with DH have no digestive symptoms of Celiac.
DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as Dapsone. Because Dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.
The only treatment for Celiac Disease is a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage and prevent further damage. Improvement begins within days of
starting the diet. The small intestine usually heals in 3 to 6 months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.
To stay well, people with Celiac Disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.
Some people with Celiac Disease show no improvement on the gluten-free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.
Points to Remember
- People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
- Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
- Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
- A person with celiac disease may or may not have symptoms.
- Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
- Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
- Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
- A dietitian can teach a person with celiac disease about food selection, label reading, and other strategies to help manage the disease.