Celiac Disease: Definition, symptoms and treatment

Celiac disease is a chronic autoimmune disorder triggered by consuming gluten, a protein found in wheat, rye, and barley. This condition causes the immune system to attack the lining of the small intestine, damaging the villi, which are crucial for nutrient absorption. Untreated celiac disease can lead to serious health complications, including malnutrition, osteoporosis, infertility, neurological diseases, and even cancer.

Definition

Celiac disease is an autoimmune disorder where ingesting gluten leads to damage in the small intestine. It affects genetically predisposed individuals and can develop at any age after people start eating foods or medications that contain gluten. The condition is not an allergy or intolerance but an immune-mediated response that causes inflammation and damage to the small intestine’s lining. In this digestive condition, gluten in food damages the small intestine, making it hard to absorb nutrients and causing a variety of symptoms

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Symptoms

Celiac disease symptoms vary greatly among individuals and can affect different body parts. They are often categorized into gastrointestinal and extraintestinal symptoms.

Gastrointestinal Symptoms

• Chronic diarrhea: Frequent, loose, watery stools.
• Abdominal pain: Cramping and discomfort in the stomach area.
• Bloating and gas: Swelling and a feeling of fullness in the abdomen.
• Constipation: Difficulty in passing stools.
• Nausea and vomiting: Feeling sick and vomiting.
• Weight loss: Unintentional weight loss due to malabsorption of nutrients.
• Steatorrhea: Fatty, foul-smelling stools that float due to poor fat absorption.

Extraintestinal Symptoms

• Fatigue: Persistent tiredness and lack of energy.
• Anemia: Iron-deficiency anemia, leading to pallor and weakness.
• Dermatitis herpetiformis: Itchy, blistering skin rash.
• Joint pain: Discomfort in the joints.
• Headaches and migraines: Persistent headaches.
• Neuropathy: Numbness, tingling, or pain in the hands and feet.
• Depression and anxiety: Mental health issues.
• Osteoporosis: Weak and brittle bones.
• Delayed growth and puberty in children: Slower than expected growth and delayed onset of puberty.
• Dental enamel defects: Damage to the tooth enamel.

Diagnosis

Diagnosing celiac disease involves a combination of medical history, physical examination, and specific tests.

1. Blood Tests:
   • Serology tests: Look for high levels of certain antibodies (tTG-IgA, EMA-IgA, DGP-IgA).
   • Total IgA levels: To rule out IgA deficiency, which can give a false-negative result.
2. Genetic Tests:
   • Tests for HLA-DQ2 and HLA-DQ8 genes. The presence of these genes can support the diagnosis, but their absence can rule out celiac disease.
3. Endoscopy and Biopsy:
   • Endoscopic examination: To visually inspect the damage in the small intestine.
   • Biopsy: Taking small tissue samples from the small intestine to look for villous atrophy and other characteristic changes. Providers most often use blood tests and biopsies of the small intestine to diagnose celiac disease. The biopsy would be done during an upper gastrointestinal (GI) endoscopy. For this procedure, your provider uses an endoscope (a flexible tube with a camera) to see the lining of your digestive tract and take the biopsy 2.

Treatment

The primary treatment for celiac disease is a strict, lifelong gluten-free diet. This means avoiding all foods and products containing wheat, rye, and barley. Adhering to this diet helps heal the intestine, manage symptoms, and prevent complications. Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet [[2]].

Gluten-Free Diet

• Allowed foods: Naturally gluten-free foods such as fruits, vegetables, meat, fish, eggs, dairy, legumes, nuts, and gluten-free grains (rice, corn, quinoa, millet).
• Avoided foods: Foods containing wheat, rye, barley, and their derivatives (bread, pasta, cereals, baked goods).
• Label reading: Carefully reading food labels to identify hidden sources of gluten.
• Cross-contamination: Avoiding cross-contamination with gluten-containing foods, especially in shared kitchen environments.

Nutritional Supplements

• Vitamins and minerals: Supplementing with iron, calcium, vitamin D, and B vitamins if deficiencies are identified.
• Dietary support: Consulting with a dietitian experienced in celiac disease to ensure nutritional needs are met.

Monitoring and Follow-up

• Regular follow-ups: Periodic visits to healthcare providers to monitor the condition and adherence to the diet.
• Serological tests: Rechecking antibody levels to ensure the immune response has subsided.
• Bone density tests: To monitor for osteoporosis, especially in those with a history of malabsorption.

Complications

If left untreated, celiac disease can lead to several serious complications:

• Malnutrition: Due to poor absorption of nutrients.
• Lactose intolerance: Temporary or permanent.
• Neurological disorders: Such as ataxia and neuropathy.
• Reproductive issues: Infertility and miscarriage.
• Cancer: Increased risk of intestinal lymphoma and small bowel cancer. People with celiac disease have a 2x greater risk of developing coronary artery disease and a 4x greater risk of developing small bowel cancers 3.
• Other autoimmune disorders: Increased risk of developing other autoimmune diseases like type 1 diabetes, autoimmune thyroid disease. Untreated celiac disease can lead to the development of other autoimmune disorders like type 1 diabetes and multiple sclerosis (MS) [[3]].

Conclusion

Celiac disease is a lifelong condition that requires vigilant management through a strict gluten-free diet. Early diagnosis and adherence to dietary restrictions can help prevent complications and improve the quality of life for those affected. If you suspect you have celiac disease or experience symptoms, consult a healthcare provider for proper diagnosis and treatment.