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Things to Know About Celiac Disease (Celiac Sprue)
Celiac disease results from a combination of immunological responses to an environmental factor (gluten) and genetic factors.
Celiac Disease CausesCeliac disease results from a combination of immunological responses to an environmental factor (gluten) and genetic factors. People need both a genetic predisposition and exposure to gluten in order to develop celiac disease. Immune mechanisms
QUESTIONCeliac disease is caused by an autoimmune reaction to ______________. See AnswerCeliac Disease Symptoms and Signs
The onset of celiac disease symptoms is usually gradual and coincides with the introduction of cereal into the diet. The symptoms usually diminish in adolescence. Gastrointestinal symptoms in children Because the celiac disease affects the absorption of nutrients essential for growth, children who are affected may have impaired growth and consequently short stature. Other common signs and symptoms include the following:
The onset of symptoms is usually gradual and coincides with the introduction of cereal into the diet. The symptoms usually diminish in adolescence. Gastrointestinal symptoms in adults Celiac disease usually affects adults in the third to fourth decade of life but sometimes later. The signs and symptoms of celiac disease are variable and may include the following:
Malabsorption of ingested fat results in the delivery of excessive dietary fat to the large bowel. The bacteria in the colon feast on the fats and other undigested and unabsorbed nutrients, generating intestinal gas resulting in bloating and flatulence. In addition, other substances are released, causing secretion of fluid into the intestine and hence diarrhea. Fatigue (tiredness) and weakness can result from the loss of electrolytes, such as potassium and magnesium, due to diarrhea. Nutrient and vitamin deficiencies Iron and folic acid are essential for the production of normal red blood cells (erythrocytes). Abnormalities in the absorption of iron or folic acid may result in anemia (low red blood cell count). Vitamin B-12 deficiencies can also contribute to the anemia noticed in affected persons with a mechanism similar to that of iron and folic acid deficiencies. Vitamin deficiencies may develop when malabsorption is present. Vitamins soluble in fat are commonly malabsorbed. These include vitamins K and D.
Nongastrointestinal (extraintestinal) features Skin disorders can complicate the course of celiac disease. These conditions include dermatitis herpetiformis, an itchy skin condition characterized by a rash or blisters involving the extremities, the trunk, the buttocks, the scalp, and the neck. Neurologic (nervous system) symptoms include weakness, problems with balance, and sensory changes (for example, sensation of touch and pain). Hormonal disorders, such as loss of menstruation (amenorrhea) and infertility in women, and impotence and infertility in men, are very uncommon. When to Seek Medical Care for Celiac DiseaseCeliac disease can be a debilitating condition, especially if the diagnosis is not considered early in the course of the disease. As a result, persons with any of the symptoms mentioned above (see Signs and Symptoms) or those with a family history of the disease are encouraged to seek medical advice. Because celiac disease is hereditary, close family members of persons with celiac disease should be tested for the disease. Females who are pregnant and have worsening anemia should seek medical care. This diagnosis should be considered in females with significant worsening of anemia during pregnancy. Celiac Disease DiagnosisThe likelihood of celiac disease determines the approach to diagnosis. If a low or moderate suspicion exists that celiac disease is present, a blood test for tissue transglutaminase (tTG) or anti-endomysial antibody is performed. If the likelihood that someone has celiac disease is very high or the blood test result is positive, then biopsies of the small intestinal should be performed. Genetic testing is only performed in certain circumstances. Blood tests Blood chemistry, red blood cell, and clotting test results suggest but do not confirm the diagnosis of celiac disease. The same abnormalities may be seen in many other diseases.
Serologic testsThe best diagnostic tests for celiac disease include measurements of antibody levels to endomysium and to an enzyme called tissue transglutaminase (tTG). The 2 tests are very specific for celiac disease in persons who are untreated. Measurements of antibodies to gliadin and reticulin (a part of the cell structure) are other diagnostic tests that are less specific for celiac disease. Small intestine imaging testsRadiology tests, such as small-bowel barium studies and abdominal/pelvic CT scanning, are usually not helpful in establishing the diagnosis of celiac disease. In video capsule endoscopy, a tiny camera in a capsule films the small intestine as the camera moves through it. However, this study cannot examine the tissue microscopically. These tests should be considered in the evaluation of persons with suspected celiac disease and those who have dramatic weight loss, severe abdominal pain, intestinal bleeding, a significant decrease in albumin levels, and intestinal obstruction. These symptoms may suggest the presence of tumors or ulcers in the small intestine. Small intestine biopsyThe lining of the small intestine usually consists of fingerlike projections called villi. The villi contain digestive enzymes and provide a large absorptive surface area of the small intestine. In celiac disease, the villi are destroyed because of the inflammatory and autoimmune process. Once the villi are destroyed, nutrients cannot be absorbed. Biopsy samples of the small intestine show mild, moderate, or severe destruction of the villi depending on the severity of the inflammation. Biopsy samples of the small intestine are obtained by introducing a small, flexible endoscope through the mouth, the stomach, and into the small intestine while the patient is sedated. Celiac Disease TreatmentThe treatment for celiac disease is strict avoidance of gluten in the diet.
Because lactose intolerance is common in people with celiac disease, incremental improvements occur when a lactose-free diet is introduced. Self-Care at Home for Celiac Disease
For the most part, successful control of celiac disease consists of what happens at home to modify diet, and select foods that can be eaten. Many resources are available to assist a person with choosing appropriate foods and modifying recipes to work within his or her diet. Food labels should be read carefully. Wheat and rye flours, barley, and oats are common ingredients in many products. Many products a person would not suspect contain flour, such as salad dressings. In addition, barley is used in the brewing process of beer. The following substitutions may be tried:
Celiac Disease Medications
Celiac Disease Outlook
Support Groups and CounselingCareful and extensive education of a person with celiac disease and their family is often necessary to achieve full compliance. A registered dietitian may be very helpful in providing information and educational resources. SLIDESHOWGluten-Free Diet: Popular Gluten-Free Foods in Pictures See SlideshowFromReviewed on 6/1/2022 References Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care REFERENCE: UpToDate. Patient information: Celiac disease in adults (Beyond the Basics). Patient Comments & Reviews
Can anything trigger celiac?Celiac disease can be triggered by a protein called gluten. Gluten is found in grains, like wheat, barley and rye. Changing your diet to avoid gluten often helps relieve your symptoms.
Can celiac disease be triggered later in life?Celiac disease can develop at any age after people start eating foods or medications that contain gluten. The later the age of celiac disease diagnosis, the greater the chance of developing another autoimmune disorder.
What are three important factors in the development of celiac disease?What Are the Top Risk Factors for Celiac Disease?. Having a Family Member With Celiac Disease.. Having HLA-DQ2 and HLA-DQ8 Genes.. Having Another Autoimmune Condition.. Having Certain Genetic Disorders.. |