Celiac Disease

Celiac disease is a serious autoimmune disorder that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. Gluten is a protein found in wheat, barley, and rye. When people with celiac disease eat gluten, their immune system responds by damaging the villi, small finger-like projections in the small intestine that absorb nutrients.

Celiac disease affects about 1% of the population, though many cases go undiagnosed. The only treatment is a strict, lifelong gluten-free diet. When gluten is removed from the diet, the small intestine heals, and symptoms improve. However, even small amounts of gluten can cause damage.

Celiac disease symptoms vary widely and may include:

Digestive Symptoms:

• Diarrhea
• Abdominal pain and bloating
• Constipation
• Nausea and vomiting
• Gas
• Fatty, foul-smelling stools
• Weight loss

Non-Digestive Symptoms:

• Fatigue
• Anemia (iron deficiency)
• Bone or joint pain
• Depression or anxiety
• Headaches
• Mouth ulcers
• Skin rash (dermatitis herpetiformis)
• Infertility or miscarriage
• Osteoporosis
• Neurological symptoms

Children May Have:

• Failure to thrive
• Delayed growth
• Delayed puberty
• Dental enamel defects
• Irritability
• Short stature

Some people have no symptoms (silent celiac disease) but still have intestinal damage.

Seek emergency care if:

• Severe abdominal pain
• Severe dehydration
• Signs of severe malnutrition
• Severe symptoms

Managing celiac disease requires strict adherence to a gluten-free diet:

1. Strict Gluten-Free Diet (only treatment):

   • Avoid: Wheat, barley, rye, and products containing them
   • Read labels carefully: Gluten can be in many foods
   • Be aware of cross-contamination: Separate utensils, cutting boards
   • Lifelong commitment: No exceptions
   • Even small amounts cause damage

2. Foods to Avoid:

   • Bread, pasta, cereals (unless gluten-free)
   • Baked goods
   • Beer
   • Many processed foods
   • Some medications (check with pharmacist)
   • Some cosmetics (if ingested)

3. Safe Foods:

   • Fruits and vegetables
   • Meat, poultry, fish (unprocessed)
   • Dairy products
   • Rice, corn, quinoa
   • Gluten-free grains
   • Legumes, nuts, seeds

4. Learn to Read Labels:

   • Look for "gluten-free" label
   • Check ingredient lists
   • Be aware of hidden sources
   • When in doubt, don't eat it

5. Prevent Cross-Contamination:

   • Separate toaster for gluten-free bread
   • Clean surfaces thoroughly
   • Separate cutting boards and utensils
   • Be careful when eating out

6. Nutritional Support:

   • May need supplements (iron, calcium, vitamins)
   • Work with dietitian
   • Ensure adequate nutrition
   • Monitor nutrient levels

7. Support:

   • Join celiac support groups
   • Educate family and friends
   • Work with dietitian
   • Don't isolate

• Suspected celiac disease
• Symptoms not improving on gluten-free diet
• Need for diagnosis
• Questions about diet
• Nutritional concerns
• Need for follow-up testing

• Following strict gluten-free diet
• Symptoms well-controlled
• Regular follow-up scheduled
• No new concerns

Diagnosing celiac disease involves:

1. Blood Tests (first step):

   • tTG-IgA test: Most common screening test
   • EMA test: More specific
   • Total IgA: To check for IgA deficiency
   • Other antibody tests: As needed
   • Important: Must be eating gluten for accurate results

2. Endoscopy with Biopsy (to confirm):

   • Scope into small intestine
   • Take tissue samples
   • Look for damage to villi
   • Gold standard for diagnosis
   • Must be eating gluten before test

3. Genetic Testing (sometimes):

   • HLA-DQ2 and HLA-DQ8 genes
   • If negative, celiac disease unlikely
   • If positive, doesn't mean you have it
   • Used in some cases

Important: Don't start gluten-free diet before testing, as it can affect test results.

Only Treatment: Strict Gluten-Free Diet:

1. Complete Elimination:

   • No wheat, barley, rye
   • No exceptions
   • Lifelong commitment
   • Even small amounts cause damage

2. Healing Process:

   • Intestine begins healing within days
   • Most people feel better within weeks
   • Complete healing may take months to years
   • Villi can regenerate

3. Symptom Improvement:

   • Digestive symptoms improve first
   • Other symptoms may take longer
   • Some damage may be permanent
   • Early treatment is best

4. Nutritional Support:

   • Supplements if needed
   • Ensure adequate nutrition
   • Work with dietitian
   • Monitor nutrient levels

5. Follow-up Care:

   • Regular check-ups
   • Monitor antibody levels
   • Assess healing
   • Adjust as needed

Celiac disease cannot be prevented, but:

• Early Diagnosis: Prevents complications
• Strict Diet: Prevents damage
• Regular Monitoring: Detects problems early
• Education: Helps with compliance

In celiac disease:

1. Gluten Ingestion: Person with celiac eats gluten
2. Immune Response: Immune system attacks gluten
3. Intestinal Damage: Villi become damaged and flattened
4. Malabsorption: Can't absorb nutrients properly
5. Symptoms Develop: Various symptoms appear
6. Healing: When gluten removed, intestine heals

Causes:

• Genetics: Runs in families
• Immune system: Autoimmune response
• Gluten: Triggers the response
• Environmental factors: May play a role

• Can develop at any age
• May have growth problems
• Early diagnosis important
• Family education crucial
• School accommodations needed

• Can develop at any age
• May have been undiagnosed for years
• May have complications
• Lifestyle adjustments needed

• May be newly diagnosed
• May have complications
• May need more support
• Regular monitoring important

If Untreated, Can Lead To:

• Malnutrition
• Osteoporosis
• Infertility
• Neurological problems
• Some cancers (rare, but increased risk)
• Other autoimmune diseases

There's no cure, but a strict gluten-free diet effectively treats it. The intestine heals, and symptoms resolve. However, you must maintain the diet for life.

You may experience symptoms, and intestinal damage can occur. The severity depends on the amount and your sensitivity. Most people recover, but it's important to be strict.

No. Even after healing, eating gluten will cause damage again. The diet must be lifelong, with no exceptions.

No. Celiac disease is an autoimmune disorder with intestinal damage. Non-celiac gluten sensitivity causes symptoms but no intestinal damage.

There's a genetic component, so children of people with celiac disease are at higher risk. However, not all will develop it. Screening may be recommended.