Celiac disease (also known as celiac sprue or gluten-sensitivity enteropathy) is a chronic disease of the digestive tract caused by an immune reaction to gluten ingestion. The immune reaction that occurs to gluten damages the small intestine and interferes with absorption of nutrients from food.
Background
In celiac disease when a person consumes gluten-containing foods such as wheat, rye, oats, and barley it results in an immune reaction to gluten characterized by the development of autoantibodies to tissues of the small intestine. Recently incidence of the disorder has been raising worldwide.
When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, finger-like protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats. Moreover, as the mucosa of the intestines becomes more and more damaged it starts to secrete fluids and hence promote watery stools. Additionally, many individuals develop lactose intolerance and they cannot digest lactose.
Causes
Coeliac disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
It has been noted that celiac disease is common in first-degree relatives and runs in families suggesting that genetic factors play a major role in the development of this disease. Among genetic factors, HLADQ2 and DQ8 were found to be the most important.
People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may be genetic. They include:
- Diabetes mellitus type 1;
- Autoimmune thyroid disease;
- Dermatitis herpetiformis;
- Autoimmune liver disease;
- Addison’s disease;
Gluten-containing foods
People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medicines, vitamins, and lip balms.
Gluten-containing foods include:
- Grains (wheat, rye and barley);
- Bread, cakes and pastry;
- Pasta and noodles;
- Cereals and granola;
- Processed meats and vegetarian meats;
- Soy sauce;
- French fries and chips;
- Alcoholic beverages (beer, ale etc.).
Symptoms
Celiac disease manifests with a range of different symptoms. Digestive system symptoms include long-lasting diarrhea, abdominal bloating, and weight loss related to impaired absorption of nutrients. Due to maldigestion disease also causes anemia (decreased red blood cells count in the blood), loss of bone density (osteoporosis), nervous symptoms dysfunction (limb weakness, fits, numbness and imbalance), skin rash, absence of periods (in females), and infertility.
The abdomen may appear enlarged due to bloating and enlarged, painful tongue, and swelling and fissuring in the angles of the lips become prominent due to vitamin deficiency.
Diagnosis
Initial testing for celiac disease includes detecting serum antibodies such as tissue transglutaminase IgA, anti-endomysial and deamidated anti-gliadin antibodies. Other important tests are complete blood count to check for anemia, iron studies and coagulation tests as those may be abnormal in sprue. Stool tests reveal fatty molecules that reflect indigestion. Due to malnourishment calcium absorption is also disrupted so every patient should have their bone mineral density checked.
X-ray of the intestines with ingestion of barium shows enlargement of the small intestine and fragmentary irregular distribution of barium in the gastrointentinal tract. Endoscopy is performed to assess the condition of mucosa and biopsy may be necessary to confirm diagnosis.
Genetic testing to detect HLADQ2 and DQ8 may be used to determine whether a person has celiac disease or not.
It is advised to examine other family members if they have any symptoms suggestive of celiac disease.
Management
Treatment of the celiac disease requires a strict gluten-free diet and it is essential to check all the food labels for gluten as many foods may be cross-contaminated with gluten in the process of preparation.