Gluten Sensitivity

Celiac Disease

Celiac disease, also known as gluten-sensitive enteropathy, is a chronic digestive disease in which gluten – the main protein found in wheat, rye, and barley damages the lining of the small intestine. When someone with celiac disease consumes gluten-containing foods or beverages, the gluten can’t be fully digested and interacts with the immune system of the gastrointestinal tract, triggering an inflammatory response. This damages the villi of the small intestine(those numerous hair-like extensions that line the inside of the small intestine multiplying exponentially its surface area, so that it can absorb nutrients from digested food as it passes), which causes vitamins, minerals, and other nutrients to pass through the digestive system without being absorbed. This can lead to serious nutrient deficiencies including iron-deficiency anemia or conditions such as malnutrition and osteoporosis.

Celiac disease increase an individual’s risk for other autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, or thyroid problems. It can also increase the risk for some gastrointestinal cancers.

Celiac disease is one of the most common inherited diseases and affects about 1 percent of the U.S. population. Although anyone can develop the condition, those at high risk include

• Those with a first-degree relative (such as a parent) who has celiac disease
• Those of Northern European decent
• Those who have a genetic disorder such as Down’s syndrome or Turner syndrome

Adults (especially older ones) are diagnosed more often than children, and the prevalence of celiac disease is greater in women than in men. Diagnosis often occurs 10 or more years after the condition develops, in part because there can be few or no symptoms. Sometimes, it is diagnosed for the first time after surgery, pregnancy, childbirth, a viral infection, or severe emotional stress, or when an individual seeks medical care for another condition.

Although genes play a big role in determining who develops celiac disease and when, there’s some evidence that breastfeeding while introducing gluten-containing foods, or gradually introducing gluten-containing foods into an infant’s diet between 4 and 6 months of age (not earlier or later) can reduce the risk of developing celiac disease in early childhood and possibly later in life as well.

Symptoms

Although some individuals with celiac disease might not experience symptoms, others might. A person’s age and whether he has any other diseases or conditions can affect whether he has symptoms or the types exhibited. Symptoms can include some of the following:

• Diarrhea
• Constipation
• Abdominal pain, bloating, or gas
• Nausea
• Vomiting
• Reduced gut motility
• Delayed gastric emptying
• Weakness
• Unintentional weight loss
• Failure to thrive in infants
• Short stature or delayed puberty

About 10-20 percent of those with celiac disease have dermatitis herpetiformis, a chronic skin rash. Chronic fatigue, infertility or miscarriage, neurological problems (including seizures and difficulties with memory or concentration), muscle cramps, and migraine headaches can also occur more frequently in those with celiac disease.

Diagnosing celiac disease can be difficult, especially in young children. A physician can use family history and symptoms as initial screening tools, followed by blood tests that check for the presence of antibodies (such as IgA and IgG anti-endomysial antibodies [AEMAs]) or for the autoantigen, a substance that triggers the altered immune response seen in celiac disease (IgA and IgG antitissue transglutaminase [ATTGA]). A biopsy of the small intestine is recommended for those whose blood test results are positive. If the biopsy is also positive, and if the individual improves by following a gluten-free diet, this confirms the diagnosis of celiac disease..