Celiac disease is a disease resulting from an abnormal response towards gluten. This article describes everything you need to know about it.
It is an autoimmune disease in which there is an abnormal immune response towards gliadin ( the soluble particle of gluten). This immune reaction not only destroys gluten, but it also damages the intestinal tissue that surrounds it. A damaged gut is unable to adequately absorb nutrients from your diet, which leads to malnutrition and all the consequences that derive from it.
Moreover, Celiac disease is a challenging diagnosis; many times, its symptoms are overlooked or attributed to something else ( irritable bowel syndrome is a frequent misdiagnosis). The problem is that undiagnosed patients continue eating gluten and damaging their small intestines, which leads to dire consequences.
In the United States, celiac diseases affect approximately one person in every 3000. According to recent estimates, celiac disease affects almost 1 % of the population in the western hemisphere. More than 3 million people in the United States and 3 million people in Europe are currently diagnosed with celiac disease. However, celiac disease is an underdiagnosed condition, and these numbers are probably much higher in real life.
Most patients receive a diagnosis between the ages of 8 and 12. Still, a significant group of patients is diagnosed during middle or old age. Up to 20% of patients receive a diagnosis after the age of 60.
Is celiac disease the same as gluten intolerance?
No, these two are two very different things. Gluten intolerance is actually an umbrella term that encompasses three major gluten-related disorders which are:
- Celiac Disease
- Non-celiac gluten sensitivity
- Wheat allergy
So, as you can see, celiac disease is just a subtype of gluten intolerance.
Non- celiac gluten sensitivity is an emerging medical problem different from celiac disease. Due to its recent nature, there is no clear definition or diagnostic criteria so far.
The concept of a condition called gluten sensitivity different from celiac disease emerged due to one study that identified a subgroup of patients with irritable bowel symptoms whose symptoms improved after taking on a gluten-free diet; these patients did not meet the criteria for celiac disease diagnosis.
Patients with non- celiac gluten sensitivity test negative for celiac disease, but experience gastrointestinal symptoms like stomach aches and diarrhea that improve when they stop eating gluten.
The question remains if non- celiac gluten sensitivity patients have the same risk for long term complications the celiac patients have.
Wheat allergy, on the other hand, is just that an allergy. It does not cause chronic and small damage to the small intestines that lead, not malnutrition.
This type of immune response is often temporary, and, unlike celiac disease, some patients can outgrow their allergies. Symptoms of wheat allergy are quite different from those of celiac disease and non-celiac gluten sensitivity.
These symptoms resemble the ones of every other food allergy. They include skin rash, nasal congestion, difficulty breathing, nausea, vomiting, and stomach cramps. The important thing is that these symptoms are transitory and will not cause permanent intestinal damage.
What is gluten, and where is it found?
Gluten is a term that encompasses all the different proteins found in several kinds of cereal that form an essential part of the western diet. Some of these cereals include wheat, barley, rye, and triticale.
Gluten is also artificially added to several foods (even those that do not contain these cereals) to give them consistency as shape. So, even if your typical sausage is not made of wheat, it probably has some artificially added gluten. Because these cereals are present in many common foods like bread, pasta, pizza, cakes, etc. , removing them from your diet to have a gluten-free diet can be quite challenging.
What can trigger celiac disease?
As most autoimmune disorders do, celiac disease has a significant genetic component. Celiac disease is significantly more frequent in relatives of patients with the condition than the general population.
First degree relatives of patients with celiac disease have a 10% chance of developing the disease at some point throughout their lifetimes.
In recent years, researchers have isolated specific genes related to the disease. People who have other autoimmune diseases such as lupus, type 1 diabetes, thyroid disease, and autoimmune liver disease are also more likely to develop celiac disease at some point.
Certain genetic conditions like down syndrome and Turner syndrome also increase the risk of developing the disease.
In people with celiac disease, the gliadin found in gluten acts as an antigen that promotes inflammatory mediators’ production and the activation of immune cells, which target intestinal cells, thus destroying the absorptive surface of the small bowel leading to a digestive disorder and a malabsorptive syndrome.
Let me digest some of the ideas within the paragraph above.
The immune cells within the gut recognize the gliadin component in the gluten as a foreign and harmful molecule. Therefore, they attack it by producing swelling in the gut. This situation will ultimately lead to a malfunction of the intestines. So, there will not be normal digestion of the food nor its assimilation by the body.
People with celiac disease are not benefiting from their food (malabsorption). So, this will translate into some sort of malnutrition, as we will see further.
What are the symptoms of celiac disease?
Although celiac disease is, for the most part, a GI tract disease, the consequences of malabsorption and malnutrition tend to be systemic (or impact the whole body). Therefore, celiac disease symptoms are usually divided into gastrointestinal symptoms and non-gastrointestinal symptoms.
Gastrointestinal symptoms include:
- Chronic diarrhea: This one is the most frequent digestive symptom in celiac disease. In celiac disease, diarrhea feces are typically watery or semi-formed, clear brown or gray, and tend to be a little oily. These stools have a very characteristic pungent smell. This diarrhea is usually intermittent; it comes and goes for months or even years.
- Flatulence: Flatulence results from gas release from the intestinal flora that ferments undigested nutrients. Flatulence in untreated celiac disease is excessive and explosive. It can be an important motive for anxiety and social isolation in celiac patients.
- Abdominal pain: Stomach cramps are also a frequent digestive symptom; these stomach cramps tend to come and go.
- Bloating: Inflammation in the digestive tract can lead to abdominal bloating. Interestingly enough, gluten also tends to cause bloating in people that do not have celiac disease.
What are the systemic symptoms of celiac disease?
Non-digestive symptoms include:
- Weight loss: Weight loss occurs because the intestines lose their capacity to absorb nutrients due to chronic inflammation properly.
- Fatigue: People with undiagnosed celiac disease tend to be tired all the time, which makes sense because their body is unable to pick up all the nutrients it needs to produce energy. Patients with celiac disease are also more likely to develop sleep disorders that contribute to fatigue.
- Depression: Not all signs and symptoms of celiac disease are physical ones; psychological manifestations like depression are also important factors to consider in the management of the celiac disease. Several studies have shown that depression is significantly more frequent in celiac disease patients than in the general population. The exact mechanism that leads to depression in celiac disease remains unknown. However, the risk of depression is less in those that follow a strict gluten-free diet.
- Skin rash: Some people with celiac disease also develop an itchy skin rash. Dermatitis Herpetiformis is a blistering skin rash that typically affects the knees, the elbows, and the buttocks. It appears on proximately 17% of celiac patients. Some celiac patients never develop digestive symptoms in the early stages of the disease. In those cases, dermatitis herpetiformis might be the only symptom of the disease.
What other health problems can accompany celiac disease?
The celiac disease leads to malnutrition, which, in turn, leads to a whole lot of other conditions that can seriously impair your general health.
Some of these complications include:
- Anemia: Up to 15 percent of celiac patients develop iron deficiency anemia due to the small intestine’s inability to absorb iron from your diet. In turn, anemia causes fatigue, dizziness, shortness of breath, pale skin, and brittle nails. In extreme cases, anemia can cause your heart to fail.
- Osteopenia and Osteoporosis: Osteoporosis is one of the most frequent complications of celiac disease. The inability to absorb calcium and vitamin D leads to a calcium deficiency that translates into brittle and fragile bones. Some celiac patients suffer from frequent bone fractures after minor trauma because of the fragility of their bones. Approximately 34% of celiac patients have osteoporosis.
- Bleeding: Vitamin K is an essential vitamin involved in the coagulation cascade. Thankfully this deficiency is asymptomatic in most cases, and clinical bleeding is quite rare.
- Failure to thrive: Failure to thrive is a medical term that describes children whose growth and weight gain are significantly inferior to the standard of most children of the same age. It is a common complication of celiac disease during childhood and is a consequence of malnutrition and vitamin deficiency. In some cases, failure to thrive might present as the only clinical symptom of celiac disease.
- Hormonal Imbalances: Menstruation irregularities (excess or absence), and infertility in both men and women is also an important complication of celiac disease
- Neurological problems: A calcium deficiency not only affects the bone, but hypocalcemia (low levels of blood calcium) can also lead to neurological problems such as tingling sensation on the extremities, weakness, loss of tactile sensations, sudden involuntary movements, and lack of coordination.
Can celiac disease cause lactose intolerance?
Yes, the destruction of your intestinal villosities (villous atrophy) with the necessary enzymes to transform lactose into absorbable glucose leads to lactose intolerance.
Fortunately, after your gut has had some time to heal, you might be able to begin tolerating lactose again. This process can take months or even years. Still, most patients regain their ability to process lactose sooner rather than later.
Can celiac disease cause cancer?
Unfortunately yes. Untreated celiac disease increases your overall risk of developing cancer at some point throughout your lifetime. Three main types of cancers are linked with celiac disease:
- Enteropathy associated T-cell lymphoma
- Non-Hodgkin’s Lymphoma
- Adenocarcinoma of the small intestine
Thankfully, cancer is a rare complication of celiac disease, and the great majority of celiac disease patients will never have an intestinal lymphoma. Cancer risk increases the more damage your intestine sustains. Patients with an early diagnosis that quickly start a strict gluten-free diet are less likely to suffer from these complications.
Patients that receive a diagnosis during their old age are less likely to heal quickly and are at a higher risk of developing some form of intestinal cancer. Logically, the risk increases if a patient goes undiagnosed for an extended period because, in the causes of untreated celiac disease, the intestine sustains more damage.
Some symptoms of cancer may include weight loss, enlarged lymph nodes, fatigue, and fever.
How is celiac disease diagnosed?
When the clinical suspicion arises due to your signs and symptoms, your doctor might order further testing.
The first test he will probably order to diagnose the disease is a serology. A serology consists of checking if you have specific antibodies in your blood. Three primary antibodies often present in individuals with celiac disease.
Antibodies found in celiac disease include:
- Tissue transglutaminase IgAEndomysial IgA
- Reticulin IgA
Although these antibodies are quite useful, a negative result does not rule out the diagnosis. About 2% of celiac patients have a selective IgA deficiency; this IgA deficiency can cause a false-negative result in a celiac disease antibody test.
Those with IgA deficiency should undergo testing for Tissue transglutaminase IgG antibodies instead of IgA. Individuals with an IgA deficiency should undergo further testing for celiac disease even in the absence of symptoms because they are 20 times more likely to develop an autoimmune response to gluten than the general population.
Once a patient has positive celiac disease antibodies, the next step to confirm the diagnosis is performing an upper endoscopy to take an intestinal biopsy. During that endoscopy, the gastroenterologist will detect pathologic changes in your intestine.
A pathologist will later examine the biopsy samples collected in the biopsy and look for characteristic changes. Some typical changes include villous atrophy, a proliferation of immune cells in the intestinal tissue, and microscopic colitis. The biopsy result is what provides the definitive diagnosis.
Is there a home test for celiac disease?
There is a relatively new home collection kit with a lancet to pierce the skin and a microcontainer to collect the blood sample. Once you have dropped four drops of blood into the container, the container should be sent to a certified lab that will give you a result in the next 48 hours.
What other tests are needed in celiac disease?
Although a serology and biopsy are the two cornerstones of the diagnosis, the work doesn’t stop there. Your medical team will need to run more tests to assess your overall health.
Some routine tests in celiac patients include:
- Electrolyte: Patients with celiac disease can have deficits in certain electrolytes like magnesium, potassium, and calcium.
- Protein and Albumin level: Decreased values point towards malnutrition and a low cholesterol level and low serum carotene levels.
- Hematologic tests: To rule out an iron deficiency anemia and B12 vitamin deficiency.
- Bone densitometry: Helps determine the overall conditions of your bones and the presence or absence of osteoporosis.
What is the treatment for celiac disease?
The standard treatment for celiac disease is gluten avoidance. Complete elimination of gluten from the diet is the only thing that will improve symptoms and allow the small intestines to heal.
A gluten-free diet can be challenging to the average person living in the western hemisphere because wheat and rye products are an essential part of the typical western diet. It is hard for the average American to imagine breakfast without any gluten-containing cereals. However, although a gluten-free diet is hard at first, it gets more comfortable with time.
Nowadays, many food companies specialize in making gluten-free food, which can be found in many supermarkets and specialized organic food shops. The variety of gluten-free alternatives to replace gluten-containing products increases every day.
Now it is possible to find gluten-free pasta, gluten-free pizza, gluten-free bread, and many other different foods that only ten years ago used to be made exclusively from wheat. Nowadays, most product packages are required by law to state if they contain gluten traces. But to be sure, celiac patients should avoid any of the following products unless the box specifically states ¨ Gluten free¨:
- Imitations of seafood
- Soups (if not homemade)
- Salad dressings
- Processed meats, chicken, and sausages
- Canned foods
What foods can I eat without worrying?
Fortunately, many, many different types of food do not contain gluten and are at the same time very tasty.
Some healthy gluten-free foods include:
- All fruits
- Fresh meats, pork, and chicken that have not been processed or marinated.
- Rice, beans, and lentils
- Corn and everything made from it
- Dairy products
- Starchy vegetables
- Dark Chocolate
Can taking medication help manage the disease?
In most cases, a gluten-free diet is all the treatment required; however, cases of refractory celiac disease may also need a short course of corticosteroid treatment to achieve complete healing. The prognosis or possible outcomes for this subgroup of patients tend to be poorer.
Do you have symptoms of this condition?
This tool is a celiac disease symptoms checker. It would help anyone who uses it to determine the likelihood of having this condition because it gathers the most important signs, symptoms, and risk factors for the disease. Importantly, the tool is free of charge and would only take a few minutes to use it.