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Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is an immunological response to the protein gluten, which is found in wheat, barley, and rye.
Eating gluten causes an immunological reaction in the small intestine if you have celiac disease. This reaction, over time, destroys the lining of your small intestine and stops it from absorbing some nutrients (malabsorption). Diarrhea, lethargy, weight loss, bloating, and anemia are common symptoms of intestinal injury, which can progress to significant consequences.
Malabsorption can impact growth and development in children as well as cause the symptoms noticed in adults.
Although there is no cure for celiac disease, adopting a strict gluten-free diet can help manage symptoms and promote intestinal repair in most people.
WHAT ARE THE SIGNS AND SYMPTOMS OF CELIAC DISEASE?
The signs and symptoms of celiac disease might range substantially between children and adults. Adult digestive signs and symptoms include:
- Diarrhea
- Fatigue
- Loss of weight
- Gas and bloating
- Pain in the abdomen
- Vomiting and nausea
- Constipation
However, more than half of individuals with celiac disease suffer symptoms that are unrelated to the digestive tract, such as:
- Anemia, which is caused by a lack of iron.
- Loss of bone density (osteoporosis) or bone softening (osteomalacia)
- Itchy, blistering skin rash (dermatitis herpetiformis)
- Ulcers in the mouth
- Headaches and exhaustion
- Nervous system damage, including numbness and tingling in the feet and hands, potential balance issues, and cognitive impairment
- Joint discomfort
- Spleen function is impaired (hyposplenism)
Celiac disease in children
Children with celiac disease are more prone than adults to experience digestive issues, such as:
- Vomiting and nausea
- Chronic diarrhea
- swollen stomach
- Constipation
- Gas
- Stools that are pale and stink.
- The failure to absorb nutrients could lead to:
- Infants' failure to thrive
- Tooth enamel damage
- Loss of weight
- Anemia
- Irritability
- petite stature
- Puberty is delayed.
- Attention deficit/hyperactivity disorder (ADHD), learning impairments, migraines, loss of muscle coordination, and seizures, which are all examples of neurological symptoms.
WHAT ARE THE CAUSES OF CELIAC DISEASE?
Celiac disease can be caused by your genes, gluten-containing foods, and other factors, but the exact reason is unknown. Infant-feeding patterns, gastrointestinal illnesses, and gut flora may all play a role. Celiac disease can become active following surgery, pregnancy, childbirth, viral infection, or extreme mental stress.
When the body's immune system overreacts to gluten in meals, the reaction destroys the small intestine's tiny, hair-like projections (villi). Villi are microorganisms that absorb vitamins, minerals, and other nutrients from the food you eat. If your villi are damaged, no matter how much you consume, you will not acquire adequate nutrition.
WHAT ARE THE RISK FACTORS FOR CELIAC DISEASE?
Celiac disease is more prevalent in those who have:
- A member of the family who suffers from celiac disease or dermatitis herpetiformis
- Diabetes type 1
- Turner syndrome or Down syndrome
- Autoimmune thyroid disease
- Microscopic colitis (lymphocytic or collagenous colitis)
- Addison's disease
WHAT ARE THE COMPLICATIONS OF CELIAC DISEASE?
Celiac disease, if left untreated, can lead to:
- Malnutrition: This happens when your small intestine is unable to absorb adequate nutrition. Anemia and weight loss can result from malnutrition. Malnutrition can induce delayed growth and short stature in children.
- Bone weakening: Calcium and vitamin D malabsorption can cause bone softening (osteomalacia or rickets) in children and bone density loss (osteopenia or osteoporosis) in adults.
- Infertility and miscarriage: Calcium and vitamin D deficiency might contribute to reproductive problems.
- Lactose intolerance: After eating or drinking lactose-containing dairy products, you may have abdominal pain and diarrhea as a result of small intestine damage. You may be able to accept dairy products again once your intestine has recovered.
- Cancer: People with celiac disease who do not follow a gluten-free diet are at a higher risk of getting cancer, particularly intestinal lymphoma and small intestine cancer.
- Problems with the nervous system: Some celiac disease sufferers may experience seizures or nerve damage in their hands and feet (peripheral neuropathy).
Nonresponsive celiac disease
Some celiac patients do not respond to what they consider to be a gluten-free diet. Nonresponsive celiac disease is frequently caused by gluten contamination of the diet. Working with a dietician can assist you in determining how to avoid all gluten.
Nonresponsive celiac disease patients may have:
- Bacteria that live in the small intestine (bacterial overgrowth)
- Microscopic colitis
- Pancreas dysfunction (pancreatic insufficiency)
- Irritable bowel syndrome (IBS)
- Difficulty digesting sugar contained in dairy products (lactose), table sugar (sucrose), or a form of sugar found in honey and fruits (fructose)
- Refractory celiac disease
Refractory celiac disease
In rare cases, celiac disease's intestinal harm does not respond to a gluten-free diet. This is referred to as resistant celiac disease. If you still experience signs and symptoms after following a gluten-free diet for six months to a year, you may require additional testing to rule out other causes of your problems.
HOW IS CELIAC DISEASE DIAGNOSED?
Many celiac disease sufferers are unaware of their condition. Two blood tests can aid in the diagnosis:
- Serology testing: Serology testing detects antibodies in your blood. Increased levels of certain antibody proteins indicate an immunological response to gluten.
- Genetic testing: Celiac disease can be ruled out using genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8).
Before attempting a gluten-free diet, it is critical to get tested for celiac disease. Eliminating gluten from your diet may cause blood test results to appear normal.
If the results of these tests show that you have celiac disease, your doctor will most likely prescribe one of the following tests:
- Endoscopy: This test involves inserting a long tube containing a tiny camera into your mouth and passing it down your throat (upper endoscopy). The camera allows your doctor to examine your small intestine and collect a small tissue sample (biopsy) to check for villi damage.
- Capsule endoscopy: This test employs a tiny wireless camera to photograph your whole small intestine. The camera is housed within a vitamin-sized pill that you consume. The camera collects hundreds of photographs as the capsule goes through your digestive tract and sends them to a recorder.
If your doctor suspects you have dermatitis herpetiformis, he or she may examine a small sample of skin tissue under a microscope (skin biopsy).
WHAT ARE THE TREATMENTS FOR CELIAC DISEASE?
The only approach to manage celiac disease is to follow a rigorous gluten-free diet for the rest of one's life. Gluten-containing foods, in addition to wheat, include:
- Barley
- Bulgur
- Durum
- Farina
- Grass-fed flour
- Malt
- Rye
- Semolina
- Spelt (a form of wheat)
- Triticale
A celiac disease nutritionist can assist you in developing a gluten-free diet that is healthful. Even minute levels of gluten in your diet can be harmful, even if you don't experience any indications or symptoms.
Gluten can be found in a variety of meals, pharmaceuticals, and nonfood products, including:
- Preservatives and food stabilizers, as well as modified food starch
- Medication, both prescription and over-the-counter
- Supplements for vitamins and minerals
- Herbal and dietary supplements
- Lipstick products
- Mouthwash and toothpaste
- Wafers for Communion
- Glue for envelopes and stamps
- Play dough
Eliminating gluten from your diet will progressively reduce inflammation in your small intestine, making you feel better and finally heal. Children tend to heal faster than adults.
SUPPLEMENTS FOR VITAMINS AND MINERALS
If your anemia or nutritional deficiencies are severe, your doctor or dietician may advise you to take supplements such as:
- Copper
- Folate
- Iron
- Vitamin B-12
- Vitamin D
- Vitamin K
- Zinc
Vitamins and supplements are typically taken as pills. If your digestive tract is having difficulty absorbing vitamins, your doctor may decide to administer them through injection.
FOLLOW-UP CARE
Regular medical check-ups can guarantee that your symptoms have improved as a result of the gluten-free diet. Blood tests will be used by your doctor to check your reaction.
A gluten-free diet will allow the small intestine to heal in the majority of celiac disease patients. That normally takes three to six months for children. Adults may require several years to fully recover.
If your symptoms persist or reappear, you may require an endoscopy with biopsies to assess whether your intestine has healed.
Medications for controlling intestinal inflammation
If your small intestine is significantly damaged or you have refractory celiac disease, your doctor may advise you to take steroids to reduce inflammation. Steroids can alleviate severe celiac disease symptoms while the intestine recovers.
Other medications may be utilized, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris).
Dermatitis herpetiformis treatment
If you develop this skin rash, your doctor may recommend an oral treatment such as dapsone as well as a gluten-free diet. Regular blood tests will be required if you are taking dapsone to monitor for side effects.
Refractory celiac disease
Your small intestine will not heal if you have refractory celiac disease. Then you'll almost certainly need to be assessed in a specialized facility. Celiac disease refractory can be severe, and there is presently no approved cure.