What you should know about celiac disease

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A graphic illustration of how celiac disease affects the intestinal lining. / Net photo.

If you usually take wheat products, and other kinds of food that contain gluten, it is high time you changed your diet because you could be risking catching celiac disease.

“Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestines,” says Dr Dieudonné Bukaba, a nutrition expert at Avega Clinic, Remera.

He adds that when people with celiac disease eat gluten (a protein found in wheat, rye and barley), their bodies mount an immune response that attacks the small intestine which leads to the damage of the intestinal villi.

“Taking the burden of this intestinal damage are the villi - finger-like structures lining the small intestine where nutrients are absorbed from your food into the bloodstream. Their job is to fuel, repair and help the body function; so degeneration of the villi can lead to nutrient deficiencies,” explains Dr Daniel Leffler, the director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Centre in Boston, US.

Experts say celiac disease occurs from an interaction between genes, eating foods with gluten and other environment factors, but the precise cause is not known. Infant feeding practices, gastrointestinal infections and gut bacteria are known to contribute to the development of celiac disease.

Sometimes celiac disease is triggered or becomes active for the first time after surgery, pregnancy, childbirth, viral infection or severe emotional stress

Signs and symptoms

Bukaba says the signs and symptoms of celiac disease can vary greatly and are different in children and adults but the most common signs for adults are diarrhoea, fatigue and weight loss.

He adds that adults may also experience bloating, abdominal pain, nausea, constipation and vomiting.

“However more than half of adults with this disease have signs and symptoms that are not related to the digestive system, including anaemia, loss of bone density (osteoporosis) or softening of bone (osteomalacia), itchy, blistered skin rash (dermatitis herpetiformis), damage to dental enamel, mouth ulcers, headaches and fatigue,” Bukaba says.

He adds that other likely symptoms are nervous system injury including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment joint pain, reduced functioning of the spleen (hyposplenism) acid reflux and heart burn.

“In children under two years old, typical signs and symptoms of celiac disease include, vomiting, chronic diarrhoea, swollen belly and poor appetite. Older children may experience diarrhoea, constipation, weight loss, irritability, short stature, delayed puberty, neurological symptoms include attention-deficit or hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures as well as dermatitis herpetiformis,” Bukaba explains.

He says dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.

“Dermatitis herpetiformis is often associated with changes to the lining of the small intestines identical to those of celiac disease, but the disease may not produce noticeable digestive symptoms,” he says.

When to see the doctor

Bukaba says one ought to consult a doctor if the diarrhoea or digestive discomfort lasts more than two weeks. A parent should also consult pediatrician if their child is pale, irritable, failing to grow, has potbelly and foul-smelly, bulky stools, he adds.

Bukaba says it is important to consult the doctor before trying a gluten-free diet.

He adds that celiac disease tends to run in families that is to say, if someone in your family has the condition you should ask your doctor about testing.

According to Food Allergy and Research Education, celiac disease isn’t a food allergy, much as allergies to wheat do exist but mainly start in childhood and often disappear by adulthood.

Leffler notes that one out of 100 people worldwide are estimated to have celiac disease.

“Autoimmune conditions including celiac tend to gather within families, so if you have a first-degree relative with celiac disease, you have about a 10 per cent chance of developing it. However, if you have a second-degree relative with celiac, your risk is about 4 to 5per cent higher than someone with no family members with celiac, so you should get screened once a family member tests positive for the disease,” he says.

How it is tested

Preliminary testing for celiac disease requires a simple blood test. The blood tests we have to screen for celiac are very accurate, affordable, and widely available. One is the TG test, which screens for the tissue transglutaminase antibody, a protein often found in the blood of people with celiac disease,” says Leffler.

Stefano Guandalini, the founder and medical director of the University of Chicago Celiac Disease Centre, says a positive test does not mean that you definitely have celiac disease, but it gives doctors a hint that you do.

He stresses that if a blood test is positive, a patient might go to a gastroenterologist who may run additional blood tests to confirm a celiac diagnosis and If blood tests aren’t clear, a specialist may want to do a biopsy of the small intestine or an endoscopy, a procedure where a small tube containing a camera is inserted down your throat to look for changes in the small intestine that would suggest celiac disease.

Treatment

Leffler says if you suspect to have celiac disease, it’s worth getting tested.

He adds that one of the reasons so many people are undiagnosed is that celiac can show up in so many ways. “Often you hear people have had symptoms for 10 or 20 years and have not been treated effectively.”

Leffler also says if you are suffering from persistent symptoms like abdominal pain, fatigue, diarrhoea and headaches, it is better to talk to a doctor because the sooner you are diagnosed, the quicker you can start treatment with a gluten-free diet.

“The treatment for celiac disease is lifelong adherence to a strict gluten-free diet. Only food and beverages with gluten content less than 20 parts per million is allowed. The gluten-free diet heals the villous atrophy in the small intestine, causing symptoms to resolve,” says Bukaba.

He also notes that people with celiac disease are deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12 and vitamin D, as well as in calories and protein.

After treatment with the gluten-free diet, Bukaba says most patients’ small intestines recover and are able to properly absorb nutrients again.

“However patients may continue to be vitamin B deficient as the gluten-free diet may not provide sufficient supplementation which can be remedied with a daily gluten-free multivitamin. Calcium and vitamin D supplementation may also be prescribed by your physician if your intake is not sufficient,” he explains.

Bukaba adds that medication is not normally required unless it’s a case of dermatitis herpetiformis in which medication such as dapsone or sulfapyridine is administered for a short period of time to control the rash.