Celiac Disease

Celiac disease is a digestive disease that causes your body's natural defense system (immune system) to react against its own cells. It interferes with taking in (absorbing) nutrients from food. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. People who have celiac disease cannot tolerate gluten. Gluten is a protein found in wheat, rye, and barley. With time, celiac disease will damage the cells lining the small intestine. This leads to being unable to absorb nutrients from food (malabsorption), diarrhea, and nutritional problems.

CAUSES

Celiac disease is genetic. This means you have a higher likelihood of getting the disease if someone in your family has or has had it. Up to 10% of your close relatives (parent, sibling, child) may also have the disease.

People with celiac disease tend to have other autoimmune diseases. The link may be genetic. These diseases include:

  • Dermatitis herpetiformis.

  • Thyroid disease.

  • Systemic lupus erythematosis.

  • Type 1 diabetes.

  • Liver disease.

  • Collagen vascular disease.

  • Rheumatoid arthritis.

  • Sjögren's syndrome.

SYMPTOMS

The symptoms of celiac disease vary from person to person. The symptoms are generally digestive or nutritional.

Digestive symptoms include:

  • Recurring belly (abdominal) bloating and pain.

  • Gas.

  • Long-term (chronic) diarrhea.

  • Pale, bad-smelling, greasy, or oily stool.

Nutritional symptoms include:

  • Failure to thrive in infants.

  • Delayed growth in children.

  • Weight loss in children and adults.

  • Missed menstrual periods (often due to extreme weight loss).

  • Anemia.

  • Weakening bones (osteoporosis).

  • Fatigue and weakness.

  • Tingling or other signs of nerve damage (peripheral neuropathy).

  • Depression.

DIAGNOSIS

If your symptoms and physical exam suggest that a digestive disorder or malnutrition is present, your caregiver may suspect celiac disease. You may have already begun a gluten-free diet. If symptoms persist, testing may be needed to confirm the diagnosis. Some tests are best done while you are on a normal, unrestricted diet. Tests may include:

  • Blood tests to check for nutritional deficiencies.

  • Blood tests to look for evidence that the body is producing antibodies against its own small intestine cells.

  • Taking a tissue sample (biopsy) from the small bowel for evaluation.

  • X-rays of the small bowel.

  • Evaluating the stool for fat.

  • Tests to check for nutrient absorption from the intestine.

TREATMENT

It is important to seek treatment. Untreated celiac disease can cause growth problems (in children), anemia, osteoporosis, and possible nerve problems. A pregnant patient with untreated celiac disease has a higher risk of miscarriage, and the fetus has an increased risk of low birth weight and other growth problems. If celiac disease is diagnosed in the early stages, treatment can allow you to live a long, nearly symptom-free life.

Treatment includes following a gluten-free diet. This means avoiding all foods that contain gluten. Eating even a small amount of gluten can damage your intestine. For most people, following this diet will stop symptoms. It will heal existing intestinal damage and prevent further damage. Improvements begin within days of starting the diet. The small intestine is usually completely healed within 3 to 6 months, or it may take up to 2 years for older adults.

A small percentage of people do not improve on the gluten-free diet. Depending on your age and the stage at which you were diagnosed, some problems such as delayed growth and discolored teeth may not improve. Sometimes, damaged intestines cannot heal. If your intestines are not absorbing enough nutrients, you may need to receive nutrition supplements through an intravenous (IV) tube. Drug treatments are being tested for unresponsive celiac disease. In this case, you may need to be evaluated for complications of the disease.

Your caregiver may also recommend:

  • A pneumonia vaccination.

  • Nutrients and other treatments for any nutritional deficiencies.

Your caregiver can provide you with more information on a gluten-free diet. Discussion with a dietician skilled in this illness will be valuable. Support groups may also be helpful.

HOME CARE INSTRUCTIONS

  • Focus on a gluten-free diet. This diet must become a way of life.

  • Monitor your response to the gluten-free diet and treat any nutritional deficiencies.

  • Prepare ahead of time if you decide to eat outside the home.

  • Make and keep your regular follow-up visits with your caregiver.

  • Suggest to family members that they get screened for early signs of the disease.

SEEK MEDICAL CARE IF:

  • You continue to have digestive symptoms (gas, cramping, diarrhea) despite a proper diet.

  • You have trouble sticking to the gluten-free diet.

  • You develop an itchy rash with groups of tiny blisters.

  • You develop severe weakness, balance problems, menstrual problems, or depression.