Celiac disease is a condition where the immune system responds abnormally to a protein called gluten found in wheat, rye and barley. When someone with celiac disease consumes gluten, the immune system is activated resulting in inflammation and damage to the lining of the small bowel. Inflammation of the small bowel can cause symptoms such as diarrhea and bloating but it may also lead to malabsorption of important nutrients.
Celiac disease affects both men and women at any age. It is not clear what causes celiac disease but it seems to result from the combination of environmental factors and a genetic predisposition.
Although celiac disease can not be cured, avoiding gluten usually results in healing of the damage of the bowel lining and resolution of the symptoms and the malabsorption.
Some patients with celiac disease may not have any symptoms. The most common symptoms are:
- Abdominal pain and discomfort
- Bloating and gas
- Weight loss
Patients with celiac disease may also develop:
- Osteopenia or osteoporosis (decreased bone density)
- Iron deficiency anemia (low blood counts due to decreased iron levels)
- Dermatitis herpetiformis (an itchy skin rash)
Celiac disease tends to be more common in people who have:
- A family history of celiac disease or dermatitis herpetiformis
- Down Syndrome
- Autoimmune thyroid disease
- Type 1 diabetes
- Addison’s disease
- Rheumatoid arthritis
Many people with celiac disease may remain undiagnosed for a long time as the symptoms are usually very non-specific.
Blood tests: Serologic tests can detect elevated levels of certain antibodies found in patients with celiac disease (such as anti tissue transglutaminase antibodies). Most patients with celiac disease have elevated antibody levels, however, it is important to continue to consume gluten at the time of the test as these tests can become negative with a gluten free diet.
Genetic tests are also available and they are more useful to rule out celiac disease.
Small bowel biopsies: This is done during an upper endoscopy. While you are sedated the doctor inserts a thin tube with a camera and a light at its tip from your mouth down to the small bowel. Small pieces of tissue are taken from the lining of the first part of the small bowel (biopsies). The tissue is examined under the microscope to look for inflammation and flattening of the small bowel villi.
A lifelong strictly gluten free diet is required to treat celiac disease. This requires the help of a dietitian as gluten can be found in many prepared foods as well as medications and supplements and non-food products.
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Some people experience symptoms of celiac disease when they have gluten in their diet but they do not test positive for celiac disease. Their symptoms resolve with a gluten free diet. This condition is referred to as non-celiac gluten sensitivity and non-celiac wheat sensitivity.