Coeliac Disease

Celiac Disease

Celiac disease is a condition in which the immune system reacts negatively to gluten, a protein found in barley, wheat, and rye.

For individuals with celiac disease, consuming gluten prompts an immune response in the small intestine. This reaction, with time, damages the intestinal lining, leading to malabsorption—the inability to absorb essential nutrients properly.

In addition, this damage can result in symptoms like weight loss, diarrhea, bloating, fatigue, and anemia. If left untreated, it may contribute to severe complications. Malabsorption in children causes gastrointestinal issues and can impair growth and development.

Symptoms

Celiac disease symptoms can vary widely. Additionally, they could differ in adults and children.

Adults:

Digestive symptoms among adults are:

• Fatigue
• Diarrhea
• Weight loss
• Abdominal pain
• Bloating and gas
• Constipation
• Nausea and vomiting

Over 50% of adults with celiac disease experience symptoms unrelated to the digestive tract, such as:

• Anemia; caused by iron deficiency as a result of reduced iron absorption.
• Loss of bone density (osteoporosis) or softening of the bones (osteomalacia).
• Dermatitis herpetiformis; an itchy, blistering skin rash.
• Mouth ulcers.
• Joint pain.
• Headaches and fatigue.
• Nervous system issues. Symptoms include numbness and tingling in the hands and feet, potential balance problems, and cognitive difficulties.
• Reduced spleen function.
• Elevated liver enzymes.

Children:

Digestive problems in kids with celiac disease are more common compared to adults and may include:

• Chronic diarrhea.
• Nausea and vomiting.
• Swollen abdomen.
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• Pale, foul-smelling stools.

Failure to properly absorb nutrients could lead to:

• Tooth enamel damage.
• Failure to thrive, especially in infants.
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• Weight loss.
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• Late puberty.
• Short stature (impaired growth).
• Neurological symptoms, such as learning disabilities, attention-deficit/hyperactivity disorder (ADHD), poor muscle coordination, headaches, and seizures.

Dermatitis herpetiformis

This blistering skin condition is usually caused by gluten intolerance. The rash typically appears on the scalp, buttocks, torso, elbows, or knees. Although this skin condition may not result in digestive problems, it is frequently linked to changes in the small intestine lining that are similar to those brought on by celiac disease.

In order to manage dermatitis herpetiformis, medical practitioners may prescribe medication, a gluten-free diet, or both.

Causes

Celiac disease is believed to result from a combination of genetic predisposition, gluten consumption, and other factors, though the exact cause remains unclear. Potential contributors, such as gastrointestinal infections, infant feeding practices, and gut bacteria, have been suggested but not conclusively proven. In some cases, the condition may be triggered by events like pregnancy, childbirth, surgery, viral infections, or significant emotional stress.

When the immune system reacts overly to gluten, it damages the minute, hairlike structures known as villi lining the small intestine. These villi are essential for absorbing vitamins, minerals, and nutrients from food. If they become damaged, nutrient absorption is impaired, regardless of how much food you consume.

Risk Factors

Celiac disease is more likely to occur in individuals who have:

• Type 1 diabetes.
• A family history of dermatitis herpetiformis or celiac disease.
• Autoimmune thyroid disease.
• Genetic conditions such as Williams syndrome, Down syndrome, or Turner syndrome.
• Microscopic colitis.
• Addison’s disease.

Complications

If left untreated, celiac disease can result in several serious complications, including:

• Malnutrition: The inability of the small intestine to absorb nutrients can result in anemia, weight loss, and, in children, slow growth and short stature.
• Bone weakening: In kids, calcium and vitamin D malabsorption can cause soft bones (osteomalacia or rickets). In adults, it may result in reduced bone density (osteopenia or osteoporosis).
• Infertility and miscarriage: Poor absorption of calcium and vitamin D may lead to reproductive problems.
• Lactose intolerance: Intestinal damage can lead to temporary lactose intolerance, causing abdominal pain and diarrhea when consuming dairy. This may improve as the intestine heals.
• Cancer: Individuals who do not follow a gluten-free diet face a higher risk of developing certain cancers, such as intestinal lymphoma or small bowel cancer.
• Nervous system conditions: Persons with celiac disease may develop complications like seizures or peripheral neuropathy, a condition affecting the nerves in the hands and feet.

Diagnosis

Many individuals with celiac disease are unaware they have it. Diagnosis typically involves these two blood tests:

• Serology testing. Detects antibodies in the bloodstream. A gluten-related immune response is shown by higher levels of specific antibody proteins.
• Genetic testing. Checks for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) to rule out celiac disease.

Before you try a gluten-free diet, it is crucial to first undergo celiac disease tests. Blood test results may fall within the normal range if you cut gluten from your diet.

One of these tests may be recommended if the findings of these tests confirm celiac disease:

• A long tube attached to a tiny camera is placed in the mouth and passed down the throat during this procedure. Using the camera, the doctor clearly sees the small intestine and can conduct a biopsy, where a small sample of tissue is taken to check for villi damage.
• Capsule endoscopy. This test takes photos of the small intestine using a small wireless camera. You swallow a capsule the size of a vitamin that contains the camera. The camera then records hundreds of images as the capsule passes through your digestive system and sends them to a recorder. When a complete or partial examination of the small intestine is required, this test is usually employed.

Your healthcare provider might remove a small skin tissue sample to look for dermatitis herpetiformis under a microscope.

Further testing to assess your nutritional status may be required if you have been diagnosed with celiac disease. Liver and hemoglobin enzymes and mineral and vitamin A, B-12, D, and E levels are all included. A bone density scan may also be used to evaluate the health of your bones.

Treatment Options

The only effective way to address celiac disease is to follow a strict, lifetime gluten-free diet. Apart from wheat, other gluten-containing foods include:

• Barley
• Durum
• Bulgur
• Graham flour
• Farina
• Rye
• Malt
• Semolina
• Triticale
• Spelt (a type of wheat)

A celiac disease nutritionist can assist you in creating a gluten-free, healthful diet. Remember that even if small amounts of gluten in your diet do not provoke symptoms, they can still be harmful.

Gluten may also be present in nonfood items, medications, and foods such as:

• Modified food starch, food stabilizers, and preservatives.
• Prescription and nonprescription drugs.
• Herbal and nutritional supplements.
• Vitamin and mineral supplements.
• Lipstick products.
• Communion wafers.
• Toothpaste and mouthwash.
• Envelope and stamp glue.
• Some makeup products.
• Play dough.

Eliminating gluten from your diet generally makes you feel better and finally recover by reducing inflammation in the small intestine. In comparison to adults, children typically recuperate faster.

Vitamin and mineral supplements:

Supplements may be given if you have severe anemia or nutritional deficits. These supplements include:

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• Folic acid.
• Vitamin B-12.
• Vitamin D.
• Vitamin K.
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Supplements and vitamins are typically taken as pills. You may also receive vitamins via injection if your digestive system has difficulty absorbing them.

Medications to manage intestinal inflammation:

Steroids may be prescribed to reduce inflammation if you have refractory celiac disease or significant damage to your small intestine. While the intestine heals, steroids can help with severe celiac disease symptoms.

Other medications that may be recommended include azathioprine (Azasan, Imuran) and budesonide (Entocort EC, Uceris).

Dermatitis herpetiformis treatment:

A gluten-free diet and a medication known as dapsone may be suggested for those with this skin rash. Dapsone is an oral drug, and you will require routine blood tests to monitor for side effects.

Follow-up care:

Regular check-ups with your doctor can help confirm that a gluten-free diet has improved your symptoms. Your medical team may conduct blood tests and regularly check nutritional markers to track progress.

Adhering to a gluten-free diet enables the small intestine to recuperate in most people with celiac disease. This typically takes 3 to 6 months in children, while for adults, complete recovery may take years.

An endoscopy with biopsies may be necessary to assess if your intestine has healed if your symptoms persist or reappear.

Living With

When to see a GP

If you experience diarrhea or other digestive discomfort that persists for longer than two weeks, speak with your healthcare team. It’s also advisable to talk to your child’s medical staff if they:

• Appear pale.
• Show irritability.
• Show signs of stunted growth.
• Have a potbelly.
• Pass foul-smelling, bulky stools.

Before trying a gluten-free diet, make sure you first consult with your medical staff. You may alter the outcomes of a celiac disease test if you cut down on or entirely stop eating gluten before the test.

Bottom Line

A diagnosis of celiac disease marks a significant change in your diet and lifestyle—but it’s also a turning point for the better. Before being diagnosed, you were likely consuming gluten, unknowingly causing ongoing damage to the small intestine. Also, you might have endured years of unexplained and uncomfortable symptoms. So, now that you have a clear diagnosis, you have the knowledge and tools to take control of your health and begin the journey towards recovery.