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Health Topics Mar 2, 2018
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Imagine maintaining a healthy diet, yet being malnourished — and having the ill effects of poor eating and possibly worse.
This could happen if you have celiac disease. Celiac disease is a serious, hereditary, autoimmune disorder that attacks the lining and tissue of the small intestine, in reaction to gluten – a protein found primarily in grains like wheat, rye and barley and foods containing them.
“The damage that occurs to the small intestine can be very problematic and create all sorts of digestive problems,” says Dr. Paul Jennewine. Many other symptoms that are not digestive-related can also occur.
Dr. Jennewine discusses the symptoms of celiac disease and how it’s diagnosed.
Click play to watch the video or read video transcript.
What are the symptoms of celiac disease, and how is it diagnosed?
What are the symptoms of celiac disease, and how is it diagnosed?
1) The symptoms of celiac disease range very widely, particularly in kids or children, it tends to be more of GI issues with diarrhea or constipation, abdominal bloating, abdominal cramping or discomfort. They can also be irritable and tired. In adults, it tends to be more non-specific, more vague symptoms. Again, the irritability, moodiness, weight loss. It can bring on some of the GI symptoms, but it's not as prevalent in adults as it is in kids. It's oftentimes a difficult thing to diagnose because the symptoms are very non-specific.
2) Celiac disease can be diagnosed with a blood test that looks for the antibodies to the autoimmune system that's gone haywire. That is an indicator, but it's not the finite diagnosis. The proven diagnosis is by an endoscopy down the esophagus and then a biopsy of the small intestine that proves the tissue is actually undergoing damage and is the result of the autoimmune attack.
Celiac disease damages villi. They’re tiny fingerlike projections that line the small intestine and absorb nutrients into your bloodstream. So, celiac disease can deny you the life-sustaining nutrients of the food you eat. Left untreated, celiac disease can lead to serious long-term health problems such as other autoimmune disorders, early onset osteoporosis, infertility and miscarriage, vitamin and mineral deficiencies, nervous system disorders, intestinal cancer and gall bladder malfunction.
In children, celiac disease can delay puberty, slow growth, damage tooth enamel, and cause mood changes, weight loss, and, for infants, failure to thrive.
“The damage that occurs to the small intestine can be very problematic and create all sorts of digestive problems."
What Triggers Celiac Disease?
While it’s a genetic disease that you can be born with, celiac disease can present itself at various life stages – infancy, childhood, adulthood, even the senior years.
For many adults, celiac disease lies dormant, without symptoms, until triggered by another health-related event. This could include surgery, pregnancy, childbirth, severe emotional stress or viral infections.
Celiac disease affects an estimated 1 in 100 people. Your risk, however, is 10 times greater, 1 in 10, if a first-degree relative – parent, child or sibling – has the disease.
You’re also more likely to have celiac disease if you’ve been diagnosed with another autoimmune disorder, such as rheumatoid arthritis, multiple sclerosis or lupus, Dr. Jennewine says.
Who Is At Risk For Developing Celiac Disease?
Dr. Jennewine explains the risk factors for celiac disease:
Click play to watch the video or read video transcript.
Who is at risk for developing celiac disease?
People who are at risk for developing celiac disease are those with a family member who have previously been diagnosed with celiac disease, but also patients who already themselves have a diagnosis of another autoimmune disorder. If they have rheumatoid arthritis or lupus or other diseases that affect the immune system, then they're also at risk for celiac disease.
Diagnosis of Celiac Disease
“Celiac disease can be difficult to diagnose, because the symptoms are nonspecific,” says Dr. Jennewine. In fact, more than 200 symptoms are associated with celiac disease, according to the Celiac Disease Foundation. Gastrointestinal symptoms are more common in children, while adults may have less specific symptoms such as irritability, moodiness and weight loss.
Diagnosis often begins with the deamidated gliadin (DMG) antibodies blood test. The test looks for DMG antibodies, which are present when a malfunctioning autoimmune system overreacts to gluten.
The test is “an indicator but not the finite diagnosis,” Dr. Jennewine says. “The proven diagnosis is by an endoscopy (a thin, flexible tube with a tiny camera on the end) down the esophagus and a biopsy of the small intestine that proves the tissue is actually undergoing damage.”
To assure accuracy, you must continue eating a normal diet that includes gluten in the weeks leading up to the blood test and endoscopy.
Your doctor may also order a bone density scan to see whether you’ve had bone loss as a result of celiac disease.
Treatment Of Celiac Disease
If you’re diagnosed with celiac disease, your doctor will put you on a gluten-free diet. At present, this is the only treatment for celiac disease.
To make sure your celiac disease is under control, you should see your health care provider at least once a year for a blood test and checkup.
When It’s Not Celiac Disease
Some people who have symptoms common to celiac disease don’t test positive for the disease. That is, they don’t have elevated levels of the antibodies associated with celiac disease. Instead, they may have what is known as non-celiac gluten sensitivity or non-celiac wheat sensitivity.
For these individuals, removing gluten from the diet resolves symptoms, just as for those with celiac disease.
Initially, people with non-celiac gluten sensitivity were thought to be spared the intestinal damage caused by celiac disease. But a study published in 2016 by researchers from Columbia University Medical Center found that they also suffer intestinal damage triggered by an immune reaction. Research, however, has not yet determined whether gluten is responsible for triggering the reaction.
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Source: Paul Jennewine, MD, Middletown Medical Group; Celiac Disease Foundation; National Institute of Diabetes and Digestive and Kidney Diseases
Paul R. Jennewine, MD
Middletown Medical Group
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