What Is Celiac Disease?

Celiac disease is an autoimmune condition in which eating gluten, a protein found in wheat, barley, and rye, triggers the immune system to attack the lining of the small intestine. This damages the small intestine lining and prevents the body from properly absorbing vitamins, minerals, and other nutrients.

Celiac disease affects about 1% of the population, though many people remain undiagnosed. It can develop at any age from infancy to late adulthood and runs in families. About 1 in 10 first-degree relatives (parents, siblings, children) of someone with celiac disease will also have the condition. Celiac disease is a lifelong condition, but it is very manageable with the right diet.

Signs and Symptoms

Celiac disease is sometimes called a “clinical chameleon” because it can cause a wide variety of symptoms, or sometimes no symptoms at all.

Digestive Symptoms:

• Chronic diarrhea or constipation
• Bloating and gas
• Abdominal pain or cramping
• Nausea
• Fatty, foul-smelling stools (steatorrhea)

Signs and Symptoms Outside the Digestive System:

• Unexplained iron-deficiency anemia
• Bone or joint pain
• Osteoporosis (thin bones) or abnormal fractures
• Skin rash with small, intensely itchy blisters (called dermatitis herpetiformis)
• Mouth sores
• Numbness or tingling in the hands and feet (peripheral neuropathy)
• Abnormal liver tests
• Infertility or recurrent miscarriages
• Fatigue and low energy
• Headaches or migraines
• Depression or anxiety
• Poor growth or short stature in children

Many people with celiac disease have only one or two of these symptoms, or none at all. That is why the disease is often missed or diagnosed late; the average delay in diagnosis can be many years.

Diagnosis

• Blood tests can be used to look for the abnormal presence of antibodies found in celiac disease
• Upper endoscopy (EGD): a thin, flexible tube with a camera is passed through the mouth to the small intestine. Small tissue samples (biopsies) are taken and examined under a microscope. The hallmark findings are damage to the villi (villous atrophy) and increased inflammatory cells.

Important: You must be eating gluten regularly at the time of testing. If you stop eating gluten before being tested, the blood tests and biopsies may come back falsely normal, making it impossible to confirm the diagnosis.

Treatment

Gluten-free diet is the only proven treatment for celiac disease. This means completely avoiding all foods and products containing wheat, barley, rye for life.

Key points about the gluten-free diet:

• Even small amounts of gluten can cause intestinal damage, even if you do not feel symptoms
• Always read labels carefully. Gluten can be hidden in many processed foods, sauces, medications, supplements, and even some cosmetics.
• Naturally gluten-free grains and starches include rice, corn, quinoa, potatoes, and buckwheat
• Most people with celiac disease can safely eat oats, but the oats must be certified gluten-free (free from wheat contamination). It is best to introduce oats after symptoms have improved and blood tests have normalized
• A registered dietitian with expertise in celiac disease is an essential part of your care team and can help you learn to follow the diet safely and nutritionally

 

What to expect:

• Most people notice symptom improvement within days to weeks of starting a strict gluten-free diet
• Blood test levels (tTG-IgA) typically normalize within 3–12 months
• Complete healing of the intestinal lining may take 1–2 years or longer in adults

Complications

When celiac disease is diagnosed and treated with a strict gluten-free diet, most complications can be prevented or reversed. However, untreated or poorly controlled celiac disease can lead to:

• Nutritional deficiencies: Iron, folate, vitamin D, vitamin B12, calcium, and zinc deficiencies are common and can cause anemia, fatigue, and bone loss
• Osteoporosis: Up to 60% of patients have low bone density at diagnosis; this usually improves with a gluten-free diet and appropriate supplementation
• Infertility and pregnancy complications: Untreated celiac disease can contribute to infertility, miscarriage, and low birth weight; these risks improve with treatment
• Increased cancer risk — There is a small increased risk of certain cancers, particularly intestinal lymphoma and small bowel cancer. This risk is highest in people diagnosed later in life and decreases with adherence to a gluten-free diet

The good news: With timely diagnosis and a strict gluten-free diet, most people with celiac disease can expect significant improvement in symptoms, healing of the intestine, and a normal quality of life. Early diagnosis and consistent follow-up are the keys to staying healthy.  Contact our team at Salem Gastro for an evaluation if you are experiencing concerning signs or symptoms.