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Celiac Disease

(Celiac Sprue; Nontropical Sprue; Gluten-Sensitive Enteropathy)

Definition

Celiac disease is an autoimmune disease of the digestive tract. In celiac disease, eating food with gluten damages little bulges in the small intestine. These bulges, called villi, absorb nutrients from foods. The condition affects the absorption of all nutrients. Untreated patients often become malnourished.
Cross Section of Small Intestine
small intestine villi
Inner circle demonstrates little protrusions affected by Celiac disease.
Copyright © Nucleus Medical Media, Inc.

Causes

Doctors do not fully understand what causes celiac disease. Eating gluten seems to be involved. There is most likely a genetic factor. Patients with specific genes develop the disease after exposure to gluten. There is some evidence that earlier exposure in infancy can cause a more severe disease than later exposure.

Risk Factors

Risk factors that increase your chance of having celiac disease include:
  • Family members with celiac disease
  • History of another autoimmune disease, such as:
  • Dermatitis herpetiformis—A skin condition associated with celiac disease
  • Rheumatoid arthritis

Symptoms

Symptoms vary and may start in childhood or adulthood. Children often have different symptoms than adults. Symptoms may not develop if a large section of the intestine is undamaged. Malnutrition may produce the first signs of the condition, which are often the most serious.
Signs and symptoms may include:

In Children

  • Abdominal pain
  • Nausea, lack of appetite
  • Vomiting, in later stages of disease
  • Diarrhea
  • Bulky stools with a strong odor
  • Irritability
  • Short stature
  • Delayed puberty
  • Pale skin
  • Seizures
  • Cracked sores in the corners of the mouth
  • Shallow sores inside the mouth

In Adults

  • Bloating
  • Gas
  • Diarrhea
  • Foul-smelling, light-colored, oily stool
  • Weight loss
  • Hearty or a poor appetite
  • Fatigue
  • Abdominal pain
  • Bone pain
  • Behavior changes
  • Muscle cramps and joint pain
  • Seizures
  • Dizziness
  • Skin rash
  • Dental problems
  • Missed menstrual periods
  • Infertility
  • A change in limb sensation

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Blood tests may be done to look for malnutrition or anemia. Celiac disease may be suspected based on symptoms and related conditions. However, the symptoms are common to several other conditions. Other tests will help to confirm celiac disease including:
  • Bowel biopsy—a sample of tissue removed for testing to look for cell level changes.
  • Endoscopy—to allow your doctor to examine your intestines.

Treatment

A life-long, gluten-free diet is the only treatment for celiac disease. It is very effective. Symptoms usually go away within days of starting the diet. However, healing of the villi may take months or years. Additional intake of gluten can damage the intestine, even if you have no symptoms. Delayed growth and tooth discoloration may be permanent. Nutritional supplements, given through a vein, may be needed if the intestinal damage does not heal. Since gluten is added to many foods, the diet can be complicated and often frustrating. Some patients find support groups helpful.

Dietary Changes

You must avoid all foods containing:
  • Wheat
  • Rye
  • Barley
This includes most bread, pasta, cereal, and processed foods. Special gluten-free breads and pastas are available. They are made with potato, rice, soy, or bean flour. A dietitian can assist you with meal planning.
Gluten is found in some unexpected foods and beverages. Carefully read all labels. Other foods with gluten include:
  • Flavored coffee
  • Beer
  • Tuna in vegetable broth
  • Packaged rice mixes
  • Some frozen potatoes
  • Creamed vegetables
  • Commercially prepared vegetables, salads, and salad dressings
  • Pudding
  • Some ice cream
  • Many other products
Ordering at restaurants can be especially challenging, since many foods on the menu may contain gluten.

Screening and Supplements

Patients with celiac disease should be tested to make sure they are getting enough nutrients. Bone density testing may also be needed. If you lack vitamins or minerals, the doctor may advise taking supplements. However, once the disease is under control with a gluten-free diet, this is often not necessary.

Prevention

There are no guidelines for preventing celiac disease because the cause is not understood. If celiac disease runs in your family, ask your doctor about a screening test. The earlier you start the gluten-free diet, the less damage there will be to the intestine.

RESOURCES

Celiac Disease Foundation http://www.celiac.org

Celiac Sprue Association http://www.csaceliacs.org

CANADIAN RESOURCES

Canadian Celiac Association http://www.celiac.ca

Health Canada http://www.hc-sc.gc.ca

References

Celiac disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2012. Accessed January 28, 2013.

Celiac disease: what you should know. Am Fam Physician. 2006;74(11):1921-1922. Available at: http://www.aafp.org/afp/20061201/1921ph.html. Accessed January 28, 2013.

Celiac sprue. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2012. Accessed January 28, 2013.

What I need to know about Celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac%5Fez/. Updated May 10, 2012. Accessed January 28, 2013.

2/13/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pelkowski T, Viera A. Celiac Disease: Diagnosis and Management. Am Fam Physician. 2014 Jan 15.

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