DEFINITION
What is celiac disease?
Celiac disease (pronunciation, see-lee-ek) is a condition in which the lining (mucosa) of the small intestine is damaged by ingestion of gluten. Gluten is a protein found in certain grains including wheat, rye, barley and triticale.
The lining of the small intestine normally has very tiny finger-like projections called villi. These villi help to absorb nutrients from the diet into the blood. In celiac disease, when gluten is ingested, the immune system of the patient causes inflammation and damage to these villi. This can lead to various symptoms and an inability of the body to absorb nutrients like carbohydrates, protein, fat, minerals and vitamins. This can cause a variety of health problems and complications.
Removal of gluten from the diet leads to healing of the intestine with resolution of the symptoms and nutritional problems. Therefore, celiac disease may be considered as a sensitivity or allergy to gluten.
PREVALENCE
How common is celiac disease?
Celiac disease is a common medical condition found in various parts of the world. It has been reported from North and South America, Europe, Africa, Middle East, Iran and India. In the United States and Europe, 1 in 100 children may be affected by this disorder.
Although the true prevalence of celiac disease in Pakistan is not known, it is felt to be a common problem. It is especially common in Punjab but is also present in other provinces.
It is estimated that celiac disease affects 0.5% to 1% of the world population although the majority of affected individuals have not yet been diagnosed. If these estimates are true, celiac disease will be one of the most common chronic gastrointestinal disorders.
SYMPTOMS
What are the symptoms of celiac disease?
Some of the common symptoms of celiac disease include the following:
- Abdominal pain
- Diarrhea
- Indigestion and gas
- Constipation
- Nausea and vomiting
- Abdominal distension
- Lack of weight gain
- Weight loss
- Fatigue
- Lack of blood (anemia)
- Weak bones (osteoporosis)
Additional symptoms in children include irritability, growth failure, short stature and dental enamel defects.
Celiac disease should also be suspected in cases of increased liver enzymes, infertility, epilepsy, ataxia and neuropathy.
An individual may have one or more symptoms. In some people the symptoms may be mild and they do not feel very ill. Such individuals may not seek medical help and hence the diagnosis may be delayed or missed altogether. Celiac disease can present at any age when the person starts to eat food items containing gluten. Therefore, this disease can present in childhood, adolescence, adulthood or old age.
Celiac disease is a hereditary disorder. Immediate relatives including siblings, parents and children of the patient with celiac disease are at high risk of developing this disorder. Celiac disease is also common in patients with type-I (insulin dependent) diabetes and thyroid disease.
DIAGNOSIS
How is celiac disease diagnosed?
There are serological (blood) tests now available to screen for celiac disease. However, in most cases, the definitive test to confirm celiac disease is a small intestinal biopsy.
Biopsy is a tiny sample taken from the lining of the small intestine and examined for inflammation. The patient is given sedation, and a flexible tube is introduced through the mouth and advanced into the small intestine from where the biopsy is taken. This procedure is called endoscopy. This is a relatively safe procedure performed by physicians who specialize in intestinal diseases (gastroenterologist).
If the screening serological test is very strong positive, a second blood test may be required. If that is also positive, celiac disease can be diagnosed using this No-biopsy approach. Patients should not self-diagnose themselves with blood tests alone and should consult their physicians for proper interpretation.
TREATMENT
How is celiac disease treated?
Currently, there is no cure for celiac disease.
The only treatment for celiac disease is a strict gluten-free diet for life. The intolerance to gluten in permanent and does not go away over time. The person must refrain from ingesting wheat, rye, barley, triticale and foods and beverages that may contain any of these grains.
Since dietary restriction is for life, it is important that gluten-free diet not be started until the diagnosis is confirmed with an intestinal biopsy.
Once gluten is removed from diet, the symptoms improve and the individual can lead a fairly normal and healthy life. Initially some patients may have difficulty digesting milk and milk products (lactose intolerance). They may have to avoid dairy products for a few months. Also, a multivitamin tablet taken daily for a few months after diagnosis is beneficial. Iron and other mineral deficiencies may have to be corrected if present at diagnosis.
Regular follow-up with the physician and dietitian is important.
It is important to remember that celiac disease is a treatable disorder. It can be effectively treated by consuming a strict gluten-free diet.