Celiac Disease


Definition:

  • Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.[1]










Causes:
  • It's not clear what causes Celiac disease, which is also known as Celiac sprue, nontropical sprue and gluten-sensitive enteropathy. Doctors know that something happens in people with Celiac disease to cause the body's immune system to overreact in response to gluten in food. [2]

  • Normally, your small intestine is lined with tiny, hair-like projections called villi. Resembling the deep pile of a plush carpet on a microscopic scale, villi work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease results in damage to the villi. Without prominent villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.[3]

  • While the exact cause of Celiac disease is unknown, doctors have discovered that it often runs in families. If someone in your family has been diagnosed with Celiac disease, you may have an increased risk of the disease. Researchers have discovered that some gene mutations seem to increase the risk of Celiac disease, but having those gene mutations doesn't mean you're certain to have Celiac disease. This means that other risk factors play a role in whether you'll develop Celiac disease. [4]


Signs and Symptoms:
There are many signs and symptoms of Celiac disease, all of which may not necessarily be present in someone with the disease. Since Celiac disease causes damage to the small intestine, some of the main symptoms are related to the lack of absorption of nutrients, such as anemia (weakness and easy fatigue due to not enough red blood cells) or osteoporosis. GI symptoms can also present themselves, such as bloating, poor weight gain, or diarrhea. However, 50% of Celiac patients have few or no obvious symptoms, and some may be overweight upon diagnosis. The following is a more extensive listing of symptoms, all of which may or may not occur.

GI problems:
  • Diarrhea
  • Steatorrhea (fatty stools)
  • Foul-smelling stools
  • Abdominal pain bloating
  • Apathy
  • Poor weight gain
  • Nausea and vomiting
  • Constipation
  • Unexplained weight loss
  • Lack of appetite

Problems caused by malabsorption that may occur with time:
  • Fatigue
  • Bruising easily
  • Depression or anxiety
  • Mouth ulcers
  • Muscle cramps/joint pain
  • Nosebleeds
  • Seizures
  • Tingling and/or numbness in the hands or feet
  • Hair loss
  • Dermatitis herpetiformis - itchy skin rashes or blisters (pictured below)
  • Dermatitis, herpetiformis - close-up of lesion
    Dermatitis, herpetiformis - close-up of lesion

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The following signs and symptoms are common in children with Celiac disease, along with the symptoms listed previously:
  • Delayed puberty
  • Slowed growth, or shorter than normal height for their age
  • Changes in tooth color and enamel
  • Irritable or fussy behavior



Medical Treatment:
Diagnosis:
Proper medical treatment begins with an accurate diagnosis of Celiac disease. It is important to know that there is no cure for Celiac disease. However, by following a well balanced gluten-free diet and being diligent of receiving proper nutrition, a symptom free life is very possible. You may be at a higher risk of developing Celiac disease if you have a family member with Celiac disease, chronic diarrhea, irritable bowel syndrome, premature bone disease, type 1 diabetes or infertility.
There are a couple of different methods that doctors use to diagnose Celiac disease. This may be a blood test, edoscopy for biopsy of intestinal tissue, or capsule endoscopy. Descriptions of the different methods are as follows:

Blood tests: This is usually the first step that doctors take in diagnosing Celiac disease. Blood tests can detect several special antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Your doctor will order these antibody tests if Celiac disease is suspected. If the levels of antibodies in your blood are elevated, this can indicate an allergic reaction to gluten. Blood and antibody tests can detect Celiac disease even if symptoms are extremely mild or almost nonexistant.

Endoscopy: If your blood tests are positive, your doctor will order an endoscopic exam to observe your small intestine (duodenum) and to take a tissue sample. The specimen is checked for damage to the villi (tiny, hairlike projections from the small intestine that absorb vitamins, minerals and other nutrients from the food you eat). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.

Capsule endoscopy: This is very similar to a regular endoscopy, but this procedure use a small camera to look at the inside of the small intestine without taking a tissue sample. The camera is usually positioned inside a vitamin-sized capsule that the patient swallows. A benefit of this procedure is that it can allow doctors to see the entire small intestine and not just the first one to two feet of the small intestine, as in a regular endoscopic exam.

A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests are to evaluate your response to treatment. If the results are normal, it can mean that you have responded to treatment. This would confirm the diagnosis of Celiac disease.

Disease Care and Medications
Up to half of Celiac patients don't heal completely even with a gluten-free diet, as found by a Celiac disease study. If this is the case, these patients are observed by medical and nutrition staff closely to monitor the intestinal healing. While the most effective treatment is a gluten-free diet, sometimes the patient with Celiac disease needs just a little help with healing to boost treatment. In these situations, a doctor may prescribe certain medications such as steroids or immune suppressants. Most commonly, corticosteroids such as prednisone are prescribed for a short term use in addition to the gluten -free diet. This would be to help control intestinal swelling and therefore prevent malabsorption of nutrients. Immune suppressant drugs would work in a way to help fight against the antibody production type reaction the body has when certain foods are ingested.

Another common form of medical treatment for Celiac disease would be vitamin and mineral supplementation. As patients with Celiac disease very commonly experience malabsorption of nutrients, supplementing nutrition can be key. In most cases, it will be recommended by a health professional for the patient to take a multivitamin daily. Iron should also be supplemented for individuals with iron deficiency anemia. Vitamin B12 and folic acid should be supplemented if the individual has an anemia due to a B12 or folic acid deficiency. If certain lab blood values are abnormal, vitamin K, calcium and vitamin D may also be supplemented.

Disease Outlook

Healing most often occurs within 3 - 6 months after starting treatment in children, but may take 2 - 3 years in adults. By following a gluten-free healing the damage to the intestines and preventing further damage will take place. Certain problems caused by Celiac disease such as a shorter stature and damage to teeth may be permanent.




Dietary Treatment:






Individuals with Celiac disease must adopt a gluten-free diet for a lifetime. However, now is a better time than ever to live gluten-free. Many cooking products and restaurants are offering gluten-free options because of the increasing need. There are even a number of blogs, chat rooms, and forums to find support for a gluten-free life. Here's one example:
http://www.glutenfreefaces.com/forum/topics/new-gf-resource-free

Initially, in addition to gluten-free, a low-fat, low-residue, and lactose-free diet should be consumed. However, after a patient has been on the diet for some time, the villi in the intestine will have time to heal and regain function. At that point, fat, lactose, and fiber can slowly be added back in.

Within a gluten-free diet, an individual must always avoid foods containing wheat, rye, and barley.
Examples of food with gluten:
  • bulgur
  • durum flour
  • farina
  • graham flour
  • kamut
  • samolina
  • spelt
  • wheat flour, or anything with the word "wheat" in it
Other foods should only be consumed if the label states "gluten-free":
  • beer
  • bread
  • cakes
  • imitation meat
  • pastas
  • soups
  • others

However, it is good to know that many foods naturally come gluten-free:
  • beans
  • meats
  • fruits
  • vegetables
There are also lots of other gluten-free grains and starches:
  • quinoa
  • rice
  • soy
  • flax

Here's a website where gluten-free products can be found:
http://www.gfoverflow.com/

Because many food containing gluten are sources of many vitamins and minerals, a gluten-free diet is more prone to micronutrient deficiencies. For this reason, supplementing the diet with a multivitamin and mineral may be helpful. Be sure, however, to consume only gluten-free supplements as well. Additionally, an increased level of protein (1-2 g/kg body weight) and total calories (35-40 g/kg of body weight) is necessary.

It is important for individuals to avoid gluten for life. Even when symptoms may not be present, damage will still be done to the intestinal wall.

Here are some websites with recipes for gluten-free cooking:
http://www.food.com/recipes/gluten-free
http://allrecipes.com/recipes/healthy-recipes/gluten-free/
http://simplygluten-free.com/

References:
Yarrow, Linda. "Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders." Clinical Nutrition 2 Lecture. Kansas State University, Manhattan, KS. Lecture.

http://www.mayoclinic.com/health/gluten-free-diet/my01140

Mahan, L.K., and Escott-Stump, S. Krause's Food and Nutrition Therapy. Ed. 12. Saunders, 2008.

PudMed Health. "Celiac disease - sprue." http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/#adam_000233.disease.symptoms

"Celiac Disease." Diagnosis, Treatment. Web. 19 Apr. 2012. <http://www.mayoclinic.org/celiac-disease/diagnosis.html>.

"Celiac Disease Treatment." WebMD. WebMD. Web. 19 Apr. 2012. <http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease-treatment>.
  1. ^ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
  2. ^ http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=causes
  3. ^ http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=causes
  4. ^ http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=causes