Celiac Disease, a great masquerader

Celiac disease is an inherited digestive disorder of unknown cause that affects the small intestine. Other names for this condition are celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. If someone in your immediate family has it, chances are about 10 percent that you may have it too. Once thought rare, celiac disease has recently been estimated to affect 1 of every 141 Americans.  Those who have celiac disease cannot tolerate a protein called gluten, which is present in wheat, rye, and barley. When a person with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food.  Eventually, decreased absorption of nutrients can cause vitamin deficiencies which can lead to other illnesses affecting a number of organs.
 

Celiac disease symptoms may start in childhood or adulthood, with onset and severity influenced by the amount of gluten that is eaten.  Some of the ways that celiac disease can present include:

• An infant may have abdominal pain and diarrhea (even bloody diarrhea), and may fail to grow and gain weight.
• A young child may have abdominal pain with nausea and lack of appetite, anemia (not enough iron in the blood), mouth sores and allergic dermatitis (skin rash).
• Teenagers may hit puberty late and be short.
• Adults typically have abdominal pain, chronic diarrhea, weight loss and pale, foul-smelling stools.

Celiac disease may also present itself in less obvious ways, including irritability or depression, stomach upset, anemia, joint pain, muscle cramps, skin rash (dermatitis herpetiformis), mouth sores, osteoporosis, and tingling in the legs and feet (neuropathy).

Celiac disease appears to be an under-diagnosed condition and can be confused with other gastrointestinal problems such as irritable bowel syndrome, gastric ulcers, lactose intolerance, and parasite infections.  When suspected, a blood test (tTG-IgA test) can be performed to detect high
levels of antibodies responsible for the immune reaction.  If blood test results suggest celiac disease, a biopsy of the small intestine, performed during a procedure called upper GI endoscopy, can confirm the diagnosis.

There is no specific medicine or surgery to treat celiac disease. Instead it is "managed" through complete avoidance of gluten. Gluten-containing foods that must be avoided include:

• Breads or baked goods prepared from wheat, barley, or rye
• Cereals made from wheat, rye, or barley
• Pasta prepared from wheat, rye, barley, or semolina
• Salad dressings, gravies, sauces, and soups prepared with gluten-containing ingredients

Other less obvious sources of gluten include pre-packaged foods, lip balms, toothpastes, vitamin and nutrient supplements, and, rarely medications.

Following a gluten-free diet is a lifetime requirement for individuals with celiac disease. A gluten-free diet will stop symptoms and allow for healing of the intestinal damage. Gluten-free flour, bread, pasta, and other products are available, which makes this diet more tolerable. Improvements after starting a gluten-free diet may be especially dramatic in children.

It is very important to recognize celiac disease since, if left untreated, it can result in a number of serious conditions including malnutrition, osteoporosis, and nerve damage. Celiac disease has even been associated with a higher risk of developing colon cancer and intestinal lymphoma.

Sources for article: 
Celiac Disease from the The National Institute of Diabetes and Digestive and Kidney Diseases
What is Celiac Disease? from the Celiac Disease Foundation

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Kent Davidson MD - Health Tip Content Editor