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Conor G. Loftus M.D., Joseph A. Murray M.D.,
Division of Gastroenterology and Hepatology, Mayo Clinic,
Rochester, Minnesota, USA.
1. What is Celiac Disease (CD)?
Celiac disease (CD) is a chronic (long-term) digestive disease
in which patients have inflammation or irritation in the small
intestine, which causes difficulties with absorbing nutrients
from the diet. Patients with CD often have other family members
with the condition and are therefore susceptible to this disease.
Inflammation in the bowel occurs when a patient with CD begins
to eat food that contains gluten. Gluten is the name given
to certain types of proteins found in wheat, barley, rye and
related grains. Oats are currently considered not to be toxic
to persons with CD. However, due to the high possibility of
contamination with other gluten containing grains, oats are
typically not recommended for people with celiac disease.
When food containing the gluten protein arrives in the small
bowel, the immune system reacts against the gluten, causing
an inflammatory reaction in the wall of the bowel. The small
intestine lining is covered by millions of villi (see diagram),
which act to increase the surface area of the intestine allowing
improved absorption of food. The villi or finger like projections
of the small intestine are temporarily damaged by the inflammation
in CD, which decreases absorption of food. When gluten is
removed from the diet inflammation is reduced and the intestine
begins to heal. The time when a patient develops symptoms
varies from patient to patient after their first contact with
the gluten protein.
Normal small bowel lining covered by villi which
are destroyed by inflammation in celiac disease
2. How common is Celiac Disease?
Approximately 1 out of every 250 people may have CD though
only 1 out of 10 people with celiac disease may be actually
diagnosed and are aware that they have this disease. Some
of these patients have mild forms of the disease and may have
no symptoms or only mild symptoms. There may be as many as
1 million people in the United States and 3-5 million in the
world with CD.
3. Who does Celiac Disease affect?
CD affects whites more often than non-whites. Infants and
children may have celiac disease, but CD is more commonly
diagnosed in adulthood, and people can be diagnosed even in
their seventies or eighties. Females are more likely to have
celiac disease than males.
4. What are the main symptoms of Celiac
Disease?
The symptoms or signs of disease will depend on how much
and how badly the intestine is inflamed. Some people have
mild inflammation with few symptoms. Even though they may
feel quite well there is still damage occurring to the lining
of the bowel. Other people have more severe inflammation,
which causes symptoms that may be severe enough to lead them
to visit their doctor. Occasionally individuals will not have
any symptoms even though their small intestine is severely
inflamed.
The most common symptoms are:
- Abdominal pains
- Bloating and gas
- Diarrhea
- Stools that may float or smell very bad
- Weight loss
- Poor growth or weight loss in children
- Anemia (low blood count)
Other symptoms are:
- Feeling weak
- Tiredness
- Low vitamin levels - especially iron, calcium and folate
- Bone and joint pains
- Osteoporosis
- A skin rash that lasts
Someone with celiac disease may have a variety of the above
symptoms and different people with celiac disease may have
completely different symptoms.
5. How is Celiac Disease diagnosed?
It is important to remember that most patients with abdominal
pain, bloating or diarrhea do not have celiac disease. In
order to test for celiac disease with blood tests and/or endoscopy
the doctor should suspect celiac disease as the cause for
the symptoms. When the doctor thinks that celiac disease is
possible, but not very likely, then blood tests alone are
done. If the blood tests are normal, other tests will not
be necessary. Sometimes the doctor strongly suspects that
the symptoms are due to celiac disease, or another similar
illness, and will request an endoscopy and biopsy (sampling
of the tissue of the small intestine). All tests for celiac
disease must be done while the patient is on a normal diet
that contains gluten. Patients who are concerned that they
may have celiac disease should probably not restrict their
diet prior to seeking medical evaluation because this may
cause false test results but they should seek prompt medical
testing.
Blood tests:
Specific antibody blood tests are used to diagnose patients
with CD. These blood tests are also used to test people who
may be at risk for having CD but have no symptoms (relatives
of patients with CD). The 2 most used tests are the endomysial
antibody and tissue transglutaminase antibody tests. Other
tests such as tests for gliadin antibodies are not as accurate
because they can be abnormal in patients who don't have celiac
disease and are healthy or in people with other digestive
problems. Other tests for allergies will not detect celiac
disease. Tests on saliva or stool for antibodies are not good
substitutes for the blood-based tests.
Endoscopy:
Establishing a firm diagnosis of CD requires taking biopsy
samples of the small bowel using endoscopy. Endoscopy involves
insertion of a thin flexible tube through the mouth into the
stomach and small bowel. Samples are taken from the wall of
the small bowel and are examined under a microscope for changes
of CD. This test is usually performed with the aid of sedatives.
6. How is Celiac Disease treated?
Celiac disease is treated by avoiding all foods that contain
gluten. Gluten is what causes inflammation in the small bowel.
When this is removed from the diet, the bowel will heal and
return to normal. Medications are not normally required to
treat CD except in occasional patients who do not respond
to a gluten free diet.
Gluten-free diet:
The
following grains contain Gluten
and are
NOT ALLOWED IN ANY FORM:
Wheat, rye, barley, kamut, einkorn, spelt and
triticale |
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Frequently overlooked foods that often contain gluten
| Breading |
Imitation
bacon |
| Broth |
Imitation seafood |
| Coating mixes |
Marinades |
| Communion wafers |
Processed meats |
| Croutons |
Sauces |
| Pastas |
Stuffings |
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Getting used to the gluten-free diet requires some lifestyle
changes. The key to understanding the gluten-free diet is
to become a good ingredient label reader. If a food has questionable
ingredients avoid it and find a similar product that you know
is gluten-free. Foods containing the following ingredients
are questionable and should not be consumed unless it is verified
that they do not contain or are not derived from prohibited
grains; these products are:
Unidentified:
Modified food starch
Hydrolyzed vegetable protein (HVP)
Hydrolyzed plant protein (HPP)
Malt vinegar
Soy sauce or soy sauce solids
Brown rice syrup
Dextrin
Textured vegetable protein (TVP)
Vegetable gum
Be aware that medications may contain gluten ingredients.
Gluten containing fillers may be in both prescription and
over the counter medications. It is essential to ensure that
any medications being taken are gluten free.
ALLOWED
Rice, corn, soy, potato, tapioca, bean, sorghum,
quinoa, millet, buckwheat, tef and nut flours
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7. For how long do you remain on the
gluten-free diet?
Once a diagnosis of CD is established, these individuals
need to remain on the gluten-free diet for the rest
of their lives. While this may be difficult at first,
patients usually adapt quite well over time.
8. Is there any other way of treating
Celiac Disease?
No. There is no other treatment currently available. All
patients with CD must remain on a strict gluten-free diet.
Medications are not normally required. Supplemental vitamins,
calcium and magnesium may sometimes be recommended but patients
are advised to check with their physician about these supplements.
Rarely steroids or other drugs are used to suppress the immune
system but only in the most severe of cases.
9. What will happen if you don't adhere
to the gluten-free diet?
Patients with CD who do not adhere to the gluten-free diet
usually continue to suffer from symptoms such as abdominal
pain, bloating, gas and diarrhea. In addition, these patients
are at higher risk for developing complications of CD such
as cancer of the small bowel and narrowings in the bowel due
to inflammation.
10. What are other complications of Celiac
Disease?
Other complications of CD that may be avoided by strictly
following a gluten-free diet include tiredness, poor growth,
decreased adult height, osteoporosis, bone pain, joint pain,
difficulty having children, narrowing of the intestine, cancer
of the esophagus (food tube) and small bowel, lymphoma (another
type of cancer) and neuropathy (unsteady walking and confusion
which may be severe).
11. Where can I find more information
on Celiac Disease?
http://www.celiac.org/
http://www.csaceliacs.org/
http://clinicaltrials.gov/ct/gui/action/FindCondition?ui=D002446&recruiting=true
http://www.naspgn.org
http://www.med.utah.edu/pated/handouts/handout.cfm?id=874
http://www.celiac.com/cgi-bin/webc.cgi/st_main.html?p_catid=21
http://www.celiac.com/cgi-bin/webc.cgi/st_main.html?p_catid=16
http://www.causeyourespecial.com/aboutus.html
http://www.allrecipes.com/directory/586.asp
http://www.celiac.com
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