Celiac Disease

What is Celiac Disease?
Celiac Disease is a condition in which the immune system responds abnormally to gluten, which can damage the lining of the small intestine. The small intestine absorbs food and nutrients, so damage to the lining of the small intestine can lead to malabsorption. Although celiac disease cannot be cured, avoiding gluten can heal the damage to the intestinal lining.

Symptoms of Celiac Disease
Symptoms vary widely. Some people with celiac disease have no symptoms at all. However, even if you do not have any symptoms, you may still not be absorbing nutrients adequately. This can be seen in blood tests. Some people have significant symptoms, which include diarrhea, weight loss, abdominal discomfort, heartburn, headaches, fatigue, arthritis, and excessive gas.

People with celiac more commonly have weakening of bones, iron-deficiency anemia, diabetes, thyroid dysfunction, dermatitis herpetiformis (skin disease related to celiac), nervous system disorders, and liver disease.

The gold standard of diagnosis for Celiac Disease is a small bowel biopsy, which Dr.Ahmed does during an upper endoscopy. Small bowel biopsy will show villous atrophy or blunting (villi are the finger-like projections in the small bowel).

There are also blood tests that can help make the diagnosis of Celiac Disease. These blood tests can also be used in patients with known Celiac, to help determine how well the disease is controlled with diet. Vitamins need to be monitored in Celiac patients as well, given the risk of vitamin and nutrient malabsorption.

Capsule endoscopy is often performed to evaluate the entire small intestine. This can help determine the severity of the disease, and assess for lesions in the small bowel.
Complications of Celiac Disease include refractory Celiac, ulcerative jejunitis, lymphoma, skin conditions, and conditions related to malabsorption. Patients who have symptoms that do not improve despite strict gluten free diet are considered to have refractory celiac disease. In these patients, steroids are used to suppress the immune system. Ulcerative jejunitis occurs in patients who have refractory Celiac that does not respond to steroids. Surgery is sometimes needed to remove the ulcerated area. Rarely, patients with Celiac develop intestinal lymphoma. This is more likely in patients who have uncontrolled Celiac. A more common complication is dermatitis herpetiformis, which is characterized by itchy, raised, red areas on the skin. Usually on the elbows, knees, buttocks, lower back, face, neck, trunk, and occasionally in the mouth. Following a strict gluten free diet will help improve this.
Gluten Free Diet – Complete, lifelong elimination of gluten from the diet is required to treat celiac disease. Gluten is a group of proteins found in wheat, rye, and barley that are toxic to those with celiac disease. Maintaining a gluten free diet is challenging and may require major lifestyle adjustments. Even small amounts of gluten can aggravate the disease, so it is important to avoid both eating gluten and being exposed to it in the air. Please see our gluten free diet page for more information. A dietician can help you to learn how to eat a nutritionally balanced gluten free diet. There are also excellent resources for people with celiac disease, including support groups, organiziations, and online resources. The popularity of gluten free foods is rising due to increased awareness of celiac disease, as well as non-celiac gluten sensitivity, and wheat allergies. Because of this, restaurants have become increasingly accommodating for people with celiac disease, and often offer a gluten free menu or ingredient substitutions.

Following a gluten free diet is crucial for people with celiac disease, even for people who have no symptoms. Strictly following a gluten free diet sometimes helps you to feel more energetic and have an improved sense of health and well being. Some people with celiac disease have vitamin or nutrient deficiencies that do not cause them to feel ill, but can cause serious problems in the long term. Untreated celiac disease also can increase a person’s risk for developing lymphoma.

Family Implications
Because this often runs in families, first-degree relatives (parents, brothers, sisters, children) of a person with celiac disease should be tested for celiac disease with a blood test and endoscopy.