Celiac Disease
Celiac disease is an immune reaction to consumption of gluten which is a protein found in barley, rye and wheat. If a person who is already suffering from celiac disease eats gluten, it leads to an immune reaction which causes inflammation and damage of the inner lining of the small intestine. The finger like structures called ‘villi’ that protrude from the epithelial lining of the intestinal wall, responsible for the absorption of nutrients, are also destroyed.
This intestinal damage can lead to loss of weight, diarrhea and bloating. Eventually, the organs such as brain, bones, nervous system and liver are deprived of nourishment. Due to malabsorption, celiac disease affects the growth and development in children.
There is no cure for celiac disease, but avoiding intake of gluten helps in reducing the symptoms and also in intestinal healing.
Normally, the immune system of the body helps to protect the body from foreign bodies. When the people affected by celiac disease consume foods containing gluten, the immune system produces antibodies against it which also attack the inner lining of the intestine. This leads to inflammation of the intestinal lining and cause damage to the villi. When the villi are damaged, the person cannot absorb essential nutrients from the food and it can lead to malnutrition.
Celiac disease is sometimes triggered first time after pregnancy, surgery, delivery, severe stress or viral infection.
The signs and symptoms vary greatly form patient to patient. Although the classic symptoms are weight loss and diarrhea, many experience few or no symptoms of the digestive system. Only about one third of people suffering from celiac disease experience diarrhea and half of them experience weight loss.
The symptoms experienced other than digestive problems include:
- Anemia due to iron deficiency
- Blistery and itchy skin called as dermatitis herpetiformis
- Osteoporosis or softening of bone (osteomalacia)
- Fatigue
- Headache
- Damage to enamel of teeth
- Joint pains
- Injury to the nervous system causing tingling and numbness in feet and hands
- Acid reflux and heartburn
- Decreased functioning of the spleen
- Duodenal erosions in the second part of the duodenum
The following tests are used to diagnose celiac disease:
- Blood Tests: Presence of antibodies against gluten in the blood indicates celiac disease. These tests are useful even when the symptoms are mild or are absent.
- Endoscopy: When celiac disease is detected through blood tests, the physician may order an endoscopy test to check the levels of damage which has occurred to the villi in small intestine.
- Capsule endoscopy: In this technique, a small wireless camera is placed inside a capsule which is swallowed. As the capsule travels in the digestive tract, it takes many pictures which are sent to the recorder.
Factors which increase the risk of getting affected by celiac disease include:
- Type 1 diabetes
- Turner syndrome or Down syndrome
- Celiac disease in other family members
- Sjogren’s syndrome
- Autoimmune thyroid disease
- Microscopic colitis
Complications:
If celiac disease is left untreated, the following complications may develop:
- Anemia and weight loss due to malnutrition
- Stunted growth in children
- Osteoporosis due to loss of calcium and bone density
- Miscarriage and infertility
- Lactose intolerance
- Cancer of small intestine
The only treatment for celiac disease is to completely avoid the consumption of gluten. The following are the foods apart from wheat which contain gluten:
- Bulgur
- Barley
- Durum
- Graham flour
- Farina
- Rye
- Malt
- Triticale
- Semolina
Once the consumption of gluten is stopped, the inflammation in small intestine reduces gradually over several weeks. Villi may heal or regrow after several months or years. It is seen that the healing of small intestine occurs faster in children than in adults.
During the treatment if gluten accidentally, diarrhea and abdominal pain may be experienced. Although some patients may not experience such symptoms, it doesn’t mean that it’s not harmful. Whether symptoms are caused or not, even trace amounts of gluten can be harmful.
Vitamins and mineral supplements: The physician may recommend vitamin and mineral supplements to the patient if severe nutritional deficiencies are seen. The following supplements are needed to be given:
- Calcium
- Iron
- Folate
- Vitamin B12
- Vitamin D
- Vitamin K
- Zinc
Vitamin supplements are usually given through the oral route in the form of capsules, but in patients where absorption is reduced they may be given by injection.
Medications:
For intestinal inflammation: Steroids may be prescribed by the doctor if there is severe inflammation in the small intestine. The other signs and symptoms of celiac disease gradually decrease with the progress of healing of the intestine.
For Dermatitis Herpetiformis: Dermatitis herpetiformis is a skin condition which accompanies celiac disease in which blistering, rashes and itching occurs. The physician may prescribe a skin medication such as dapsone to treat this condition. A gluten free diet is also to be followed along with this treatment.
