Celiac disease is a lifelong, immune-mediated digestive disorder affecting people of all ages. When a person with celiac eats a food containing gluten (a protein found in certain grains), it creates an immune-mediated inflammation that damages the small intestine. Gluten is found in wheat, rye and barley and thus these grains must not be ingested by celiac patients.
Over the last several years it has been recognized that celiac is not a rare childhood disease but rather a common disorder affecting about 1 in 133 people.
There is a wide variation of symptoms in patients with celiac disease. Symptoms may involve the digestive system as well as other organs. Digestive complaints are more commonly found in infants and young children and may include:
- Stomach pain
- Stomach distention
- Chronic diarrhea
- Vomiting
- Constipation
- Weight loss
Left untreated, celiac can harm the body's ability to absorb nutrients. This is particularly dangerous in children, who require a balanced diet to grow. Mal-absorption of nutrients may result in:
• Failure to thrive in infants
• Short stature
• Delayed puberty
Extra-intestinal complaints that may be seen in celiac patients include:
- Unexplained iron-deficiency anemia
- Fatigue
- Joint pain
- Decreased bone mineralization
- Dental enamel defects of the permanent teeth
- Missed menstrual periods
- Seizures
- Infertility or recurrent miscarriages
- Canker sores inside the mouth
- Dermatitis herpetiformis (unique rash on the skin that does not go away)
- Hepatitis (inflammation of the liver, usually a mild variant that can be detected only in blood tests)
- Intestinal cancer (only in a very small fraction of celiac patients, and only after many years of gluten consumption; gluten free diet eliminates this risk).
Celiac disease was found to be associated with other medical conditions including:
- Type 1 diabetes
- Autoimmune thyroiditis
- Down syndrome
- Williams syndrome
- Turner syndrome
- Selective IgA deficiency
First degree relatives of celiac patients are at a higher risk of developing celiac (compared with the general population). In any case where a clinical suspicion arises, and in cases of familial occurrence, patients should undergo testing for blood markers. High levels of celiac antibodies (TTGA, DGP, AEM) are suggested of celiac disease. These tests are difficult to interpret if the immunoglobulin IgA is low. Therefore, IgA levels must be obtained concurrently with the celiac markers. If the markers are positive, a biopsy of the small intestine is performed in order to confirm the diagnosis. The biopsy is obtained during a gastroscopy (or upper endoscopy). In select patients, genetic testing may be used to clarify the presence or risk of celiac.
The only treatment for celiac disease is strict adherence to a gluten-free diet, which means refraining not eating foods that contain wheat, rye and barley. To assist with the diet many patients are seen by dieticians and obtain information and guidance from celiac support groups. Adherence to a gluten-free diet may decrease the morbidity in celiac patients to levels found in the general population and thus must be continuously adhered to.
Following diagnosis and treatment, patients with celiac are periodically followed by their gastroenterologist for assessment of complaints, growth and adherence to treatment. Celiac markers are followed to demonstrate adherence to the gluten-free diet.
Adherence to the dietary guidelines, though hard at first, promises that celiac patients will lead a completely normal life.