The human digestive system
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Celiac disease is an autoimmune digestive disease that affects at least 1 in 133 Americans (roughly 1 percent of the population). People with celiac disease, also called celiac sprue or gluten-sensitive enteropathy, cannot eat gluten.
Gluten is a protein found in foods processed from wheat and other grains. Exposure to gluten damages the lining of the small intestine, interfering with the absorption of nutrients from food and often causing abdominal pain. The word "celiac," sometimes spelled "coeliac" or "cœliac" is derived from the Greek koiliakós, abdomen.
In the past few years, awareness of the genetic disorder has increased and many food companies and restaurants now offer menus that cater to those with celiac disease.
Who is at risk?
Studies show that men and women of any age and race can be affected by celiac disease, but is more prevalent in those of Northern European descent. Because the disease is genetically based, it is more common in those who have a first-degree relative (parent, child or sibling) or second-degree relative (grandparent, uncle, aunt, cousin, niece, nephew or half-sibling) with celiac disease.
There are two main genes related to celiac disease. Ninety-five percent of people with celiac disease will have the HLA-DQ2 gene, and the other 5 percent have the HLA-DQ8 gene. Genetic testing is often used to calculate the risk for celiac disease. However, having the gene means that you are simply at risk for developing disease and is not a conclusive diagnosis. Positive genetic tests should be followed up with celiac blood panels and possibly biopsies, depending on the result of the blood panels. If the genetic tests return with negative results, the patient can essentially rule out celiac disease.
When a person with celiac disease consumes gluten, the immune system overreacts and targets the body’s small intestine. The villi — hair-like structures in the small intestine — suffer shortening and flattening. This occurs in the lamina propria and crypt regions of the intestine when the patient eats specific food-grain antigens, or toxic amino acid sequences. These toxic amino acid sequences are found in wheat, rye, and barley. Research shows that some celiac sufferers can tolerate oats, while others cannot.
Symptoms of celiac disease
There are nearly 300 symptoms related to celiac disease, but the classic symptoms are diarrhea, weight loss and malnutrition. There are also latent symptoms, like isolated nutrient deficiencies, depression, or irritability, but many of those with celiac disease have no gastrointestinal symptoms. Because there is such a wide variation of symptoms, diagnosis can be difficult. On average, diagnosis for each patient takes six to 10 years.
Some of the most common symptoms of celiac disease include:
- Gas and bloating
- Skin problems
- Delayed growth
- Headaches or migraines
- Diarrhea or constipation
- Mouth sores
- Bone density problems
- Mood swings and fatigue
- Joint pain
Some people with celiac disease exhibit no symptoms at all and are completely in the dark about their diagnosis. Many take this to mean that if there are no symptoms, then there isn't a problem, but that simply isn’t true. Celiac disease, if left untreated, can cause a myriad of serious life threatening problems because of its nature as an autoimmune disorder.
Patients with celiac disease who do not follow a gluten-free diet often suffer from malnutrition. In children, this can cause stunted growth, delayed development, and behavioral issues. For women, untreated celiac disease can lead to infertility and miscarriage, as well as other reproductive issues because of the malabsorption of calcium and vitamin D. Celiac disease can cause bone weakness and nerve damage, causing constant pain. Most unnerving, people with untreated celiac disease have a significantly greater risk of developing several forms of cancer, including lymphoma and small bowel cancer.
Diagnosis and treatment
Because the symptoms of celiac disease can mimic other diseases like irritable bowel syndrome and Crohn’s disease, the best way to diagnose celiac disease is to start with a blood test. Currently, doctors test for total IgA, IgA-tTG, IgA-EMA, and possibly IgG/IgA-DGP or IgG-AGA. It’s important that the patient continue to consume gluten before the blood tests to properly measure the immune system’s response to that diet. If the blood tests come back positive, the doctor will likely do a biopsy of the small intestine via endoscopy to confirm the diagnosis.
The earlier the disease is diagnosed, the easier it is for your body to heal the damage. There is only one way to treat celiac disease: a lifelong gluten-free diet. This diet must be strict, as even the smallest amount of gluten can trigger damage to the small intestines and reverse the healing process. Full healing in children usually takes six months, while full healing can take much longer for adults. Some people who have had symptoms for an extended period of time may take longer than two years to heal, and some will never fully recover. Many advanced complications of the disease may not be reversible, like infertility and severe bone loss. However, the gluten-free diet will ease many symptoms significantly once implemented.
Removing gluten from your diet completely is a difficult transition. Wheat, rye, and barley are common in many foods, like bread, pasta, baked goods, and pizza. But even small amounts can cause a reaction, and this can be found in products like candies, chocolates and many snack foods. It’s also important for those with celiac disease to avoid cross-contamination in their own kitchens or at restaurants. For example, if a restaurant serves battered chicken fingers and have only one fryer, everything cooked in that fryer will be contaminated with the batter. So even French fries, which do not normally contain wheat as an ingredient, would not be safe if cooked in this oil.
As awareness of celiac disease has grown, so have options for those with celiac disease. Many gluten-free alternatives are available, like gluten-free bread, gluten-free pasta, and gluten-free baked goods. The gluten-free food industry is booming, and is expected to exceed more than $5 billion by 2015. They are made with potato, rice, soy, or bean flour. Relief for many celiac disease sufferers can happen almost immediately after starting the strictly gluten-free diet.
Celiac disease should not be confused with a gluten sensitivity, intolerance or allergy. Though gluten sensitivity often has the same symptoms as celiac disease, it does not cause the same damage and risks that celiac disease does. Food allergies occur when a body’s immune system overreacts to a food and produces IgE antibodies as a reaction, producing histamines and causing skin, breathing and heart problems. This process is very different from what happens when a celiac sufferer consumes gluten. Though they both are overreactions of the immune system, food allergies are often characterized by anaphylactic reactions and hives, whereas celiac disease is characterized by the reaction in the small intestine and other listed symptoms. Food allergy exposures can be immediately life threatening and can also be treated with an Epipen, whereas gluten exposures for celiac sufferers cannot.
Living with celiac disease can be daunting and cause anxiety. There are a number of support groups, including the Celiac Sprue Association and Healthy Villi. These support groups help people with Celiac disease express their frustrations about the diagnosis, share recipes, and try new food items together.