Celiac disease is a digestive disorder that can damage your small intestine. It is an autoimmune disorder. It can be triggered by a protein called gluten found in grains like wheat, barley, and rye. The intestinal damage often causes bloating, diarrhea, weight loss, fatigue, and anemia. It can further lead to severe complications.
What Causes Celiac Disease?
- Factors that may cause Celiac disease include:
- Eating foods with gluten.
- Genes – almost always occur in people with one of two groups of normal gene variants called DQ2 and DQ8.
- Changes in gut microbiota.
- Infant-feeding practices, gastrointestinal infections might also be the cause.
What are the Risk Factors?
- Following conditions may increase the risks.
- People who have other autoimmune disorders and certain genetic disorders are also more likely to have celiac disease.
- Lupus
- Rheumatoid arthritis
- Type 1 diabetes
- Thyroid disease
- Autoimmune liver disease
- Addison’s disease
- Sjogren’s syndrome
- Down syndrome or Turner syndrome
- Lactose intolerance
- Intestinal cancer
- Intestinal lymphoma
- A family history of celiac disease or dermatitis herpetiformis
- Autoimmune thyroid disease
- Microscopic colitis (lymphocytic or collagenous colitis)
Signs and symptoms of Celiac disease:
The most common symptoms include:
In Adults:
- Diarrhea.
- Fatigue.
- Weight loss.
- Bloating and gas.
- Abdominal pain.
- Nausea and vomiting.
- Constipation.
- Iron deficiency anemia.
- Osteoporosis or Osteomalacia.
- Itchy, blistery skin rash – dermatitis herpetiformis.
- Mouth ulcers.
- Headaches and fatigue.
- Tingling sensation in the legs. It is due to nerve damage and low calcium).
- Joint pain.
- Reduced functioning of the spleen.
In Children:
- Nausea and vomiting.
- Chronic diarrhea.
- Swollen belly.
- Constipation.
- Gas.
- Pale, foul-smelling stools.
What are the Complications?
Untreated, celiac disease can cause:
- Malnutrition.
- Bone weakening – due to malabsorption of calcium and vitamin D.
- Infertility and miscarriage.
- Lactose intolerance – temporary.
- Cancer – e.g., intestinal lymphoma and small bowel cancer.
- Nervous system problems – such as seizures or a disease of the nerves to the hands and feet (peripheral neuropathy).
Diagnosis: How to diagnose Celiac Disease?
- Medical history – Check for symptoms and other risk factors.
- Physical Examination –
- Tiredness.
- Hepatosplenomegaly.
- Abdominal tenderness with distention.
- Scaly rash on extensor surfaces.
Diagnostic tests – The tests performed are:
- Blood tests – Two blood tests can help diagnose it:
- Serology testing – to measure levels of antibodies to gluten in blood; elevated levels of specific antibodies indicate an immune reaction to gluten.
- Genetic testing for human leukocyte antigens (HLA-DQ8 and HLA-DQ2) can be used to rule out celiac disease.
- Endoscopy – enables the doctor to view the small intestine. A doctor removes a small tissue sample (biopsy) to analyze for damage to the villi.
- Capsule endoscopy – the test uses a tiny wireless camera to take pictures of the entire small intestine. It is placed inside a vitamin-sized capsule, which the patient swallows.
- Skin biopsy – to check for dermatitis herpetiformis.
Treatment: How is it treated?
o Surgery:
1. Surgery is not used to treat celiac disease per se but rather to treat complications of the disease, including bowel obstruction, perforation, bleeding, and malignancy (cancer).
o Medications:
- Medications to control intestinal inflammation – steroids, azathioprine (Azasan, Imuran), or budesonide (Entocort EC, Uceris), might be used.
- Treating dermatitis herpetiformis – Dapsone.
- Other treatments: Lifelong gluten-free diet is the only way to manage celiac disease.
Prevention: Can we prevent Celiac Disease?
o Prevention –
1. Celiac disease cannot be prevented.
2. Although early detection and management of celiac disease may prevent severe complications
o Living with the disorder –
1. Avoid packaged foods unless they’re labeled as gluten-free or have no gluten-containing ingredients, including emulsifiers and stabilizers that can contain gluten.
2. Foods not allowed include – cereals, pasta, baked goods, candies, gravies, rice mixes, soups, etc.
3. Foods that are allowed include – eggs, fresh meats, fish, and poultry that aren’t breaded, batter-coated, or marinated, fruits, lentils, nuts, potatoes, vegetables, etc.
4. Grains allowed include – Amaranth, Buckwheat, Corn, Cornmeal, Gluten-free flours (rice, soy, corn, potato, bean), Quinoa, Rice, Tapioca, etc.
When to see a doctor?
- Always consult a gastroenterologist immediately if observed any symptoms. The typical consultation fee for a gastroenterologist ranges from ₹ 500 to ₹ 1500 in India.