Celiac Disease

(Gluten Intolerance, Celiac Sprue)

The Facts

Celiac disease is also called celiac sprue, non-tropical sprue, and gluten-sensitive enteropathy. It is a hereditary autoimmune condition in which a person has a delayed immune reaction to gluten (a protein that causes dough to be sticky) found in cereals, such as wheat, barley, and rye. This reaction causes the immune system to attack the lining of the small intestine, damaging it so that it can't absorb nutrients from food.

Celiac disease affects almost 1% of people in Canada. Recent research has revealed that, contrary to what was previously believed, celiac disease may be just as common in places like Africa, South America, and Asia. The disease affects 10% of first-degree relatives and is about twice as common in women as in men.

The Causes

The lining of a normal small intestine is covered with finger-like projections called villi. The villi are covered with tiny hair-like endings called microvilli, which trap and absorb nutrients from food. In celiac disease, the villi flatten out or disappear due to the immune reaction caused by eating foods that contain gluten. The villi lose their shape and their microvilli, resulting in the damage to the intestinal lining.

Although it was once thought of as a condition that always started in childhood, it is now known that celiac disease can develop at any age in susceptible individuals. You are more susceptible if you have a family history of celiac disease, have type 1 diabetes, or if you have other autoimmune conditions such as thyroiditis. There is a strong association between Down syndrome and celiac disease. In older people, celiac disease can be triggered by an intestinal infection or some other intestinal condition.

Symptoms And Complications

A person with celiac disease isn't able to absorb the nutrients from food. This problem of malabsorption can cause vitamin and mineral deficiencies. Iron deficiency from malabsorption causes anemia, which is a reduction in red blood cells. This can lead to fatigue and tiredness. Symptoms of celiac disease can include serious diarrhea, bloating, and cramps.

The food that isn't absorbed is excreted in feces. Too much diarrhea can lead to severe dehydration. Bowel movements are often bulky, light tan or grey, and frothy or rancid-smelling because the stools contain fat that couldn't be absorbed. The feces often stick to the toilet bowl because of the large amount of fat in them.

People with celiac disease often lose weight because their bodies can't absorb the much-needed nutrients from the foods they eat. Lack of vitamins and minerals may lead to many different complications. People who lack protein will have swollen legs. Lack of vitamin K causes bleeding gums. Some people's nerves will be affected and they may have trouble thinking or concentrating. Others may have dry skin or sore lips and tongue. Sometimes, people with celiac disease have osteomalacia (softening of bones) due to nutritional deficiencies. About 10% of people with celiac disease will develop an itchy rash that affects the knees, buttocks, elbows, shoulders, and scalp.

As a result of modern testing procedures (see "Making the Diagnosis"), we now know that some people with celiac disease may not have the typical intestinal symptoms that doctors used to think were required to make the diagnosis of celiac disease. If you experience certain more general symptoms such as anemia, abnormal liver function, or arthritis, your doctor may recommend that you get tested for celiac disease. Infertility can also occur if you have celiac disease.

Making A Diagnosis

To diagnose celiac disease, the doctor will conduct tests and ask about symptoms and their relationship to food. These tests usually include blood tests and an examination of your small intestine by taking a sample of the intestinal tissue.

Blood tests look for certain antibodies that a person with celiac disease may produce in higher-than-normal amounts. These antibodies are a sign that the body is mistaking gluten for a foreign substance and trying to remove it from the body.

If further testing is indicated, your doctor will insert a thin tube called an endoscope into the intestine. A tissue sample of the lining of the small intestine is taken to be examined under a microscope. The doctor then examines the cells to search for signs of celiac disease.

Treatment And Prevention

People with celiac disease must avoid eating gluten-containing foods. This means that they can't eat bread products made with wheat, rye, or barley. Gluten is also found in many prepared foods such as pasta. Until recently, people with celiac disease were advised to avoid oats. We now know that oats themselves do not contain gluten, though they may be contaminated in processing.

People with celiac disease have to carefully check the labels on processed foods for gluten. They shouldn't buy any processed food unless they know exactly what's in it. They should also be careful to check if the vitamins and medications they are taking contain any gluten. Fortunately, more and more gluten-free food options are becoming available.

Keeping the body hydrated is important. Taking vitamin and mineral supplements may also be helpful to compensate for the problems of malabsorption. Once the person begins to follow the gluten-free diet, the bowel begins to heal and the problem of malabsorption may go away.

It can be difficult to follow a truly gluten-free diet so it's important to make a definite diagnosis of celiac disease. If celiac disease is diagnosed, a gluten-free diet must be followed for the rest of your life. Some people find it helpful to speak with a nutritionist to learn how to adopt a gluten-free diet.