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Celiac disease: An Introduction To a Not-So-Rare Problem

Once thought to be a rare childhood disease, celiac disease is now recognized as a common condition that is primarily a disease of adulthood. A University of Maryland study has shown that approximately 1 in 150 Americans has celiac disease, and women are affected three times more often than men. What is this not-so-rare disease? Celiac disease, also called celiac sprue, gluten sensitive enteropathy, and non-tropical sprue, is an autoimmune disease which affects the small intestine and interferes with the body's ability to absorb nutrients from food. In celiac, the "trouble-maker" is gluten, a protein found in all forms of wheat (spelt, triticale, kamut, durum, semolina, einkorn, faro), rye, barley, and possibly oats.

Gluten is found not only in food but also in some medicines, vitamins, minerals, toothpaste, lipstick, and adhesives on postage stamps and envelopes, to mention a few sources.

The immune system responds to the gluten by destroying the small hair-like villi lining the small intestine which allow nutrients from food to be absorbed into the bloodstream. Since iron and calcium are absorbed in the small intestine, celiac patients can develop iron deficiency anemia and osteoporosis. Vitamin B12 deficiency can also lead to other forms of anemia.

What causes celiac disease? Autoimmunity is generally accepted as the cause of celiac disease. As happens in other autoimmune diseases, a combination of genes, environmental triggers, and hormones are likely factors in developing the disease.

A celiac patient must have specific genes to develop the disease. Two genes have been identified in celiac disease, the HLA-DQ2 and HLA-DQ8 genes. Seventy percent of identical twins have the disease when one twin is diagnosed. Also, 10 percent of first-degree relatives (parents, siblings, children) will have celiac disease.

While gluten is the known primary environmental trigger for celiac disease, other triggers are possible. Repeated viral infections in infants and children are thought to trigger celiac disease, and surgery also may be a trigger. Hormones may be a factor since celiac is often activated after childbirth when a woman's hormonal balance changes markedly. It is known that testosterone levels in men with celiac are lower than the general population.

Breast milk appears to offer some protection against the disease by safeguarding children from developing celiac and in delaying its onset in children who eventually develop the disease. It is known that children who are not breastfed and who are given gluten early in life or in large amounts are more likely to develop celiac.

What are the symptoms of celiac? Most people who have celiac disease do not have any recognizable symptoms, or they consult their doctors for a variety of complaints. Symptoms can occur in the intestinal system or in other parts of the body. The disease affects each person differently, and symptoms may come on gradually or appear suddenly and dramatically. These celiac disease symptoms can include any of the following: gas/flatulence, reflux, abdominal bloating and pain, chronic diarrhea, constipation, fatigue and depression, anemia, osteoporosis, bone or joint pain, muscle cramps, tooth discoloration and/or loss of enamel, and pale, foul-smelling or fatty stool. Symptoms also can include tingling and numbness in the legs, missed menstrual periods, weight loss or weight gain, sores inside the mouth, and seizures.

Approximately 10 percent of celiac patients have a skin disease called dermatitis herpetiformis, and males are twice as likely to be affected as females. This is an intensely itchy, blistery rash that appears most commonly on the elbows, knees, and buttocks. The rash is commonly mistaken for mosquito bites, eczema, psoriasis, herpes, and a number of other skin conditions. A biopsy will confirm a diagnosis.

What are the symptoms of celiac in children? In addition to the symptoms already mentioned, irritability is one of the most common symptoms in children. Behavioral changes may also be noted, including an inability to concentrate. Children may complain of always feeling hungry.

Early diagnosis is critical since malnutrition and anemia from celiac can lead to serious problems including delayed growth, short stature, bone loss, and cognitive problems. Many celiac children are diagnosed with ADD, ADHD, and other cognitive issues. Children are rarely affected by dermatitis herpetiformis.

The good news is that children heal quickly once they follow a strict gluten-free diet. Within three to six months, the small intestine can be completely healed.

How is celiac diagnosed? Getting a diagnosis can be very difficult since its early symptoms may mimic other autoimmune diseases. It is often misdiagnosed as irritable bowel syndrome.

Patients are tested for the following autoantibodies: IgA endomysial antibodies (EMA), IgA tissue transglutaminase (tTGA), IgG tissue transglutaminase, and IgA and IgG antigliadin antibodies (AGA). Total IgA testing might also be done since patients with celiac disease have an increased IgA deficiency. If the blood tests and symptoms suggest celiac disease, a small intestine biopsy will be performed.

What is the treatment for celiac disease? The treatment for celiac disease is to follow strictly a gluten-free diet. For most people, avoiding gluten will stop the symptoms and heal existing damage. Adults who follow the diet show improvement almost immediately, and the small intestine is usually completely healed within two years.

It is important to remember that a gluten-free diet must be followed for life. Eating even trace amounts of gluten can cause damage to accumulate.

The treatment for dermatitis herpetiformis is also a strict gluten-free diet. Rash symptoms can be relieved with medications, e.g., dapsone and sulfapyridine. However, these medications are not a treatment for celiac disease.

What research is being done? Researchers are studying the substances in gluten that destroy the immune response in celiac disease. Alternatives to a gluten-free diet also are being explored. Various drugs and immunizations are being investigated. Researchers are currently investigating oral peptidases, which are enzymes that could digest the toxic components in gluten.

---Source: Adapted from "Celiac Disease: The Facts," American Autoimmune Related Diseases Association; available free upon request.