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Celiac Disease

Celiac disease (CD) is also referred to as gluten sensitive enteropathy (GSE), gluten intolerance, or celiac sprue. It is considered to be the most under-diagnosed common disease today, potentially affecting 1 in every 133 people in the USA. It is a chronic, inherited disease, and if untreated can ultimately lead to malnutrition. Gluten intolerance is the result of an immune-mediated response to the ingestion of gluten (from wheat, rye, and barley) that damages the small intestine. Nutrients then quickly passed through the small intestine, rather than being absorbed. To develop celiac disease (CD) three (3) things must be present: 1) you must inherit the gene, 2) consume gluten, and 3) have the gene triggered. Common triggers may include stress, trauma (surgeries, pregnancy, etc.), and viral infections. Approximately 1 in 20 first-degree relatives could have CD triggered in their lifetime. The disease is permanent and damage to the small intestine will occur every time you consume gluten, regardless if symptoms are present.

To read more about the recently published multi-center prevalence study of celiac disease visit, http://archinte.ama-assn.org/cgi/content/abstract/163/3/286

Symptoms 

Celiac disease was once thought of a disease with only GI symptoms. It is now recognized that the disease is a multi-symptom, multi-system (organ) disease. Celiac disease also does not routinely present with the 'textbook' symptoms that physicians learn. More often it presents with symptoms that can mimic other problems.
Most physicians recognize the classic symptoms of celiac disease : diarrhea, bloating, weight loss, anemia, chronic fatigue, weakness, bone pain, and muscle cramps. Physicians may not be aware that celiac disease frequently presents with other symptoms, some that do not involve the small intestine. More often, symptoms can include constipation, constipation alternating with diarrhea, or premature osteoporosis. Overweight persons may also have undiagnosed celiac disease. Children may exhibit behavioral, learning or concentration problems, irritability, diarrhea, bloated abdomen, growth failure, dental enamel defects, or projectile vomiting. Others will have symptoms such as rheumatoid conditions, chronic anemia, chronic fatigue, weakness, migraine headaches, nerve problems such as tingling of hands or difficulty walking, or other conditions that are unexplained and/or do not respond to usual treatment. People may have one or more of the above symptoms. Patients are frequently misdiagnosed as having 'irritable bowel syndrome', 'spastic colon/bowel', or Crohn's disease'. 

Diagnosis 

Initial screening for CD is a blood test taken by your physician. The test can be referred to as a Celiac Panel or by the names of the individual tests. To provide the most accurate information, the blood test should include the following tests: 

Tissue Transglutaminase IgA and IgG (tTG-IgA and IgG)

or Anti-endomysial Antibodies IgA (EMA IgA)

IgA Deficiency Test

These tests are very sensitive and specific for celiac disease. A gastroenterologist takes small intestine tissue biopsies if the results of the antibody test(s) are positive or he/she has a strong suspicion of CD. A biopsy showing damaged villi in the small intestine is the first half of the 'Gold Standard' to diagnosing CD. The second half of the 'Gold Standard' is improvement of health with the gluten-free diet. 
It is possible, in some situations, to have normal blood tests and still have celiac disease. 

 

Treatment 

Strict adherence to a gluten-free diet for life is the only treatment currently available. This involves the elimination of wheat, rye, barley, and derivatives of these grains from your diet. Medication is not normally required, unless there is an accompanying condition, e.g. osteoporosis, dermatitis herpetiformis, etc. Thriving, showing improvement and return of health on the gluten-free diet is the second half of the 'gold standard' of being diagnosed with CD.

Questions to Ask Your Doctor: 

Should I take nutritional supplements? 
Could I have associated food intolerances? 
Where can I have a bone density study? 
What other concerns should I have? 
How can I find out about the diet? 

Prognosis 

Excellent, if you stay on the gluten-free diet. The small intestine will steadily heal and start absorbing the needed nutrients. You should start feeling better almost immediately; however, complete recovery may take several months to years. 

Related Disorders 

Dermatitis herpetiformis is also present in some people with celiac disease. Other autoimmune disorders that people with CD are at greater risk to develop include Addison' s disease, autoimmune chronic active hepatitis, Alopecia Areata, Graves' disease, insulin-dependent diabetes mellitus (type 1), myasthenia gravis, scleroderma, Sjogren's syndrome, lupus, and thyroid disease. Thyroid diseases and diabetes are the two most commonly associated diseases found with celiac disease. Thyroid disease is most commonly associated with DH.

Other conditions frequently seen in persons with gluten intolerance include anemia, early bone disease, Downs Syndrome, and fertility problems. Some persons with DH also have a higher incidence of other skin conditions, such as eczema. 

While other connections have been suggested - such as with autism, MS, and mycosis fungoides, the research is either inconclusive, suggests a weak connection or offers no substantial connection. 

As knowledge of gluten intolerance diseases expands and new findings become available, you can expect that the list of associated health problems and conditions will also change.

 

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