CELIAC DISEASE OVERVIEW - Celiac disease is a condition in which the immune system responds abnormally to a protein called gluten, which can cause damage to the lining of the small intestine. Gluten is found in wheat, rye, barley, and a multitude of prepared foods. Celiac disease is also known as gluten sensitive enteropathy (enter-OH-pathy), celiac sprue, and nontropical sprue.
The small intestine is responsible for absorbing food and nutrients. Thus, damage to the lining of the small intestines can lead to difficulty absorbing important nutrients; this problem is referred to as malabsorption. Although celiac disease cannot be cured, avoiding gluten usually stops the damage to the intestinal lining and the malabsorption that results. Celiac disease can occur in people of any age and it affects both genders.
This topic discusses celiac disease in adults. Celiac disease in children is discussed separately.
CELIAC DISEASE SYMPTOMS - The symptoms of celiac disease vary from one person to another. In its mildest form, there may be no symptoms whatsoever. However, people with no symptoms may not be absorbing nutrients adequately, which can be detected with blood tests. As an example, a low blood count may develop as a result of decreased iron absorption.
Others people have bothersome symptoms of celiac disease, including diarrhea, weight loss, abdominal discomfort, excessive gas, osteoporosis, and other signs and symptoms due to deficiencies of specific vitamins and nutrients.
Some conditions are more common in people with celiac disease, including:
Thyroid problems (usually hypothyroidism, an underactive thyroid) Arthritis
CELIAC DISEASE CAUSES - It is not clear why some people develop celiac disease. Genetic factors are clearly important since celiac disease occurs primarily in certain groups of people, specifically whites of northern European ancestry.
CELIAC DISEASE DIAGNOSIS - Celiac disease can be difficult to diagnose because the signs and symptoms are similar to other conditions. Fortunately, testing is available that can distinguish celiac disease from other disorders.
Blood tests - A blood test can determine the blood level of antibodies (proteins) that become elevated in people with celiac disease. Over 90 percent of people with untreated celiac disease have elevated antibody levels, while these levels are rarely elevated in those without celiac disease.
Before having these tests, it is important to continue eating a normal diet, including foods that contain gluten. Avoiding or eliminating gluten could cause the antibody levels to be normal, delaying the diagnosis.
Small intestine biopsy - If the blood test is positive, the diagnosis must be confirmed by examining a small sample of the intestinal lining with a microscope. The sample (called a biopsy) is usually collected during an upper endoscopy, a test that involves swallowing a small flexible instrument with a camera. The camera allows a physician to examine the upper part of the gastrointestinal system and remove a small piece (biopsy) of the small intestine. The biopsy is not painful.
In people with celiac disease, the lining of the small intestine has a unique appearance when viewed with a microscope. Normally, the lining has distinct finger-like structures, which are called villi. Villi allow the small intestine to absorb nutrients. The villi become flattened in people with celiac disease. Once gluten is removed from the diet, the villi can resume a normal growth pattern. Approximately 70 percent of patients begin to feel better within two weeks after they stop eating gluten.
One way to determine if the gluten free diet is working is to monitor the levels of antibodies in the blood. If the levels decline on the gluten free diet, this indicates that the diet has been effective.
"Silent" celiac disease - People with a positive IgA endomysial antibody test and a normal small bowel biopsy are considered to have latent (silent) celiac disease. This group is not usually advised to follow a gluten free diet. However, ongoing monitoring is recommended and a repeat biopsy may be needed if symptoms develop. Multiple intestinal biopsies are recommended since the abnormality can be patchy.
Many clinicians recommend specific testing for bone loss. One method involves using a bone density (DEXA) scan to measures the bone density. The test is not painful and is similar to having an x-ray. People who have developed significant bone loss may require treatment to stop bone loss or encourage new bone growth.Refractory sprue - A small percentage of people develop intestinal symptoms that do not improve despite use of a gluten free diet. In other cases, intestinal symptoms initially improve with dietary changes but then return.
People who have these problems are said to have refractory sprue. The cause of refractory sprue is not known. Treatment involves medications that suppress the immune system's abnormal response (eg, steroids). Treatment is important because people with untreated celiac disease can develop anemia, bone loss, and other consequences of malabsorption.
Ulcerative jejunitis - Patients with refractory sprue who do not improve with steroids may have a condition known as ulcerative jejunitis. This condition causes the small intestine to develop multiple ulcers that do not heal; other symptoms may include a lack of appetite, weight loss, abdominal pain, diarrhea, and fever. This condition can be difficult to treat. Treatment usually involves an attempt to surgically remove the ulcerated area.
Lymphoma - Cancer of the intestinal lymph system (lymphoma) is an uncommon complication of celiac disease. Avoiding gluten can usually prevent this complication.
CELIAC DISEASE TREATMENT
Gluten free diet - The cornerstone of treatment for celiac disease is complete elimination of gluten from the diet. People who are malnourished because of the disease may also need nutritional supplements.
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