Celiac disease is name given to a medical condition of digestive system which occurs after consuming gluten, a form of protein. Gluten is present in bread, pasta, cookies, crust of the pizza and foods which made out of wheat or barley. Individuals suffering from celiac disease and who consume gluten rich foods undergo an immune reaction in their small intestines resulting in damage to inner surface of small intestine which leads to inability in absorbing some nutrients. Celiac disease may cause abdominal pain and diarrhea which leads to decreased absorption of nutrients. This malabsorption results in vitamin deficiencies which deprive the brain, peripheral nervous system, bones, liver and other vital organs of nourishment.
There is no treatment as of yet for celiac disease; however, it can be managed effectively by making lifestyle and dietary changes.
Causes and Risk Factors of Celiac Disease
The exact cause of celiac disease is not known. It is found to be hereditary. Certain gene mutations may also increase the risk of celiac disease. Following are some risk factors which increase the chances of developing celiac disease:
- Type-1 diabetes
- Down's syndrome
- Microscopic colitis
- Autoimmune thyroid disease
Signs and Symptoms of Celiac Disease
There are no specific signs and symptoms of celiac disease. Some of the common complaints are:
- Recurrent diarrhea
- Pain in the abdomen
Individuals Suffering From Celiac Disease May Also Have The Following:
- Depression/ irritability/anxiety
- Stomach problems
- Pain in the joints
- Muscle cramps
- Skin rash
- Mouth sores
- Dental problems
- Bone disorders (osteoporosis)
- Tingling in the legs and feet (neuropathy)
- Weight loss
- Generalized fatigue and weakness
- Foul-smelling stools or grayish stools which may be fatty or oily
- Growth retardation (in children)
Sometimes patients suffering from celiac disease may not have any gastrointestinal symptoms. Also, the symptoms of celiac disease can mimic other conditions such as gastric ulcers, irritable bowel syndrome, Crohn's disease, anemia and parasitic infections. So, careful diagnosis has to be made.
Investigations for Celiac Disease
- Tests may reveal depleted albumin levels, elevated alkaline phosphatase (indicating bone loss), abnormalities of clotting factor and cholesterol deficiency.
- CBC to detect anemia.
- Liver enzymes.
- Blood draws help in detecting special antibodies named antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA)
- Upper endoscopy is done if tests are positive. In this, biopsy is taken from first part of small intestine that is the duodenum which helps in revealing flattening of villi in regions of intestine present below duodenum.
- Genetic testing of the blood also helps in determining the risk of developing celiac disease.
- A follow-up blood test or biopsy may be done after several months of diagnosis and treatment in order to analyze the patient's response to treatment.
- Capsule endoscopy which comprises of swallowing a camera pill which takes pictures of the small intestine is done for diagnosis. The capsule gets eliminated via passage of stool.
Treatment for Celiac Disease
There is no known cure for celiac disease; however, it can be managed effectively by making lifestyle and dietary changes such as:
- Avoiding gluten containing foods such as barley, bulgur, wheat, durum, rye, farina, spelt (a type of wheat), graham flour, semolina, triticale etc.
- Consult a dietitian to follow a healthy gluten-free diet.
- After you have stopped consumption of gluten, the small intestinal inflammation gradually subsides and you start to feel better.
- Complete recovery, healing and re-growth of the villi can take many months (maybe 2 to 3 years). Small intestine of the children tends to heal more rapidly than an adult's.
- Accidental consumption of a gluten containing product may cause abdominal pain and diarrhea. Some individuals may not experience any signs or symptoms even after consuming gluten; however, it doesn't mean that it's not harmful, as even small amounts of gluten can be quite harmful, irrespective of whether it causes symptoms or not.
- Vitamin supplements should be taken to avoid malnutrition such as iron, folic acid, calcium, vitamin B-12, vitamin D and vitamin K. if you have trouble absorbing the vitamins orally, then your doctor may give them via injection.
- Medications such as steroids are given in order to control inflammation of the intestine
- Grains and starches which can be taken are: Amaranth, arrowroot, buckwheat, rice, corn, cornmeal, gluten-free flours (rice, soy, corn, potato, bean), quinoa, pure corn tortillas and tapioca.
- Other foods which are gluten-free are: Fresh meats, poultry and fish which are not breaded, marinated or batter-coated. Fruits, majority of the dairy products, vegetables and wine and distilled liquors, ciders and spirits.