Background Information
Celiac disease which is also called celiac sprue is a chronic digestive and autoimmune condition that damages the small intestines leading to malabsorption of nutrients from food that is consumed orally. This can lead to nutritional deficiencies.
It is triggered by consuming gluten, which is a protein found in grains such as rye, barley and wheat.
Presence of gluten in the body triggers the immune system to produce antibodies against it (immune reaction). Over time the antibodies cause damage to intestinal mucosa, impairing ability to absorb nutrients.
Celiac disease is also referred to as:
- Celiac sprue.
- Non-tropical sprue.
- Gluten-sensitive enteropathy.
Current Trends & Data
Facts and figures about celiac disease
- Celiac disease is an auto-immune condition that erodes the lining of the small intestines
- 1% of the total global population has celiac sprue.
- It is estimated that about 2 million persons in the US have this condition.
- Of all people suffering from celiac disease, it is thought that less than 20% receive the right diagnosis.
Factors That Contribute
Causative elements in celiac disease
Celiac disease is caused by an immune reaction that develops due to consumption of gluten.
This immune reaction damages villi (fingerlike projections that line the small intestine).
Villi perform absorptive role.
Therefore, with damaged villi, it becomes impossible for adequate quantity of nutrients to be absorbed.
Potential Risks Elements
Risk factors for celiac disease
- Genetic mutations in HLA-DQ2 or HLA-DQ8.
- Sex. Being assigned female at birth.
- Race. Being white.
- Family history of celiac disease. Persons with a first-degree relative (biological parent, child or sibling) with celiac sprue have 10% chance of developing the condition.
- Having auto-immune conditions such as;
- Rheumatoid arthritis.
- Type 1 diabetes.
- Autoimmune liver disease.
- Presence of chromosomal disorders such as;
- Turner syndrome.
- Down syndrome.
- Having cancers such as;
- Intestinal cancer.
- Intestinal lymphoma.
Manifestations & Indicators
Signs and symptoms of celiac disease
There are more than 150 potential signs and symptoms of celiac disease.
They vary from one person to another.
Some individuals may fail to notice symptoms at all.
Gastro-intestinal signs and symptoms:
- Stomach pain.
- Constipation.
- Fatty stool.
- Gas.
- Bloated stomach.
- Abdominal pain.
- Diarrhea.
Symptoms of iron-deficiency anemia:
- Koilonychia (brittle, spoon-shaped nails).
- Pallor of the mucosal membranes.
- Fatigue.
- Angular stomatitis.
Other symptoms of malnutrition:
- Unexplained and unintended loss of weight.
- Muscle wasting.
- Failure to thrive among the paediatric population.
Evaluation Techniques
Procedures for diagnosis
Many individuals who have celiac disease do not know that they have it. There are blood tests that can be performed to help in diagnosis. These are:
Serology testing
- This is aimed at identifying antibodies present in the bloodstream.
- Elevation in certain antibodies indicate an immune reaction to gluten.
Genetic testing
- This is done for human leukocyte antigens (HLA-DQ2 and HLA-DQ8).
- It can be used to rule out celiac disease.
- It is crucial to get tested before eliminating gluten from the diet because this can make blood test results to appear within the normal ranges.
- If the results of these tests are positive, endoscopy and capsule endoscopy are two tests which can be carried out.
Endoscopy
- A long tube with a tiny camera is inserted into the mouth and passed along the throat to view the small intestines.
- A tissue biopsy can also be taken for analysis of damage done on the villi.
Capsule endoscopy
A tiny camera is used to take pictures of the small intestine.
Approaches to Treatment & Care
Stopping consumption of gluten-containing foods is the first step to treating celiac disease. This prevents immune reactions to gluten from occurring. It also helps the small intestine to heal and nutrient absorption may begin soon. A strict gluten-free diet is recommended for life.
Additional treatment strategies include:
- Nutritional supplements aimed at correcting deficiencies.
- Medications to treat complications. For example, dapsone for dermatitis herpetiformis.
- Corticosteroids for severe inflammation.
Possible Consequences
Complications of untreated celiac disease include:
- Development of other autoimmune conditions such as multiple sclerosis and type 1 diabetes.
- Iron deficiency anemia.
- Dermatitis hypetiformis. This is a chronic dermatologic condition that develops in about 15% of celiac disease patients.
- Osteoporosis.
- Osteopenia.
- Rickets (in children) and osteomalacia (in adults) due to long-term malnutrition.
- Neurological conditions such as seizures and epilepsy.
- Intestinal cancers.
- Infertility and miscarriage
- Vitamin and mineral deficiencies.
Complications of chronic inflammation include:
- Additional food intolerances such as lactose intolerance.
- Ulceration and scarring in the small intestine.
- Cancer of the small intestine.
- Liver disease.
- Compromised immunity.