Celiac Disease: Symptoms, Causes, Risks, Complications, Diagnosis and Treatment

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celiac disease

1Overview

Today, many products are made gluten-free. It’s not just another food fad or craze; it’s a precautionary measure for people who can’t eat gluten because it will damage their small intestine, also called celiac disease.

What is celiac disease? Celiac disease is a severe autoimmune disorder wherein the consumption or ingestion of gluten may lead to the damage in the small intestine by triggering the body’s immune response.

Like any other autoimmune disease, in celiac disease, the body’s immune system will attack the small intestine that may damage the villi, which are the small finger-like projects on the lining of the intestines. These villi are responsible for the absorption of the nutrients in food.

Over time, the exposure to gluten leads to the damage of the small intestine and the prevention of absorption, which is also called malabsorption. Children with malabsorption can affect their growth and development. This disease may also cause serious complications.

Gluten is the protein found in wheat, barley, and rye. It is mainly found in foods and other products such as vitamins. Supplements, some medicines, lip balm and even the glue on envelopes.

An estimated 1 in 133 people in the United States or about 1 percent of the population has celiac disease. This condition can affect both men and women of all ages and races.

2Symptoms

The signs and symptoms of celiac disease may differ for children and adults. Moreover, people with celiac disease may have one or more symptoms. In some individuals, they have no symptoms, but a life event such as surgery, pregnancy and health issues like bacterial gastroenteritis, viral infection and severe mental stress may trigger the emergence of these symptoms.

Adult Symptoms

However, more than half of adults who have celiac disease may experience symptoms that are not related to the gastrointestinal area such as:

  • Loss of bone density like osteoporosis
  • Softening of the bones (osteomalacia)
  • Iron deficiency anemia
  • Dermatitis herpetiformis – itchy and blistery skin rash
  • Mouth ulcers
  • Damage to the teeth enamel
  • Fatigue
  • Headache
  • Joint pain
  • Hyposplenism or impaired functioning of the spleen
  • Acid reflux or heartburn
  • Injury to the nervous system like tingling sensation in the hands and feet, problems with balance, numbness and cognitive problems.

Symptoms in Children

Young children who are two years old and below, the typical symptoms of the condition include:

  • Chronic diarrhea
  • Vomiting
  • Enlarged abdominal area
  • Poor appetite
  • Failure to thrive
  • Muscle wasting

Other symptoms include:

  • Constipation
  • Weight loss
  • Irritability
  • Delayed puberty
  • Impaired growth
  • Short stature
  • Neurological symptoms like headaches, lack of muscle coordination, seizures, learning problems and in some, the development of attention deficit hyperactivity disorder (ADHD).

3Causes

The exact cause of celiac disease is still unclear, like many other autoimmune diseases. Scientists have been studying about why the immune system attacks the body’s tissues and cells. However, there are theories on the causes of celiac disease.

Many scientists suggest that celiac disease develops as a result of the interplay of various factors like genes, environmental triggers, and eating foods with gluten.

Genetics

According to studies, gene variations may predispose a person to develop celiac disease. However, the gene variants are not the only possible cause of celiac disease because additional factors may play a role in the disease process.

Autoimmune Response

The celiac disease develops when the immune system overreacts to gluten in food. As a result, the antibodies attack the villi that line the small intestines. These villi are important in the absorption of vitamins, minerals and other nutrients from food. As a result, no matter how much you eat, if your villi are damaged, your body can’t absorb these important nutrients.

Environmental Factors

Many causes of celiac disease emerged after a stressful life event, infant feeding practices, gut bacteria, pregnancy, childbirth, surgery, viral and bacterial infections or severe emotional or mental stress.

4Risk Factors

People who have relatives or immediate family members who have celiac disease are at a higher risk of developing the condition. Moreover, if a person has the genetic variant for the disease, an infection or stressful event could trigger changes in the small intestines.

Despite the fact that celiac disease can affect anyone, some people are at a heightened risk of developing the disease like those who have:

5Complications

People with celiac disease should never eat food with gluten, no matter how small the ingredient is. This could still trigger an autoimmune response and may lead to the damage of the small intestines. Here are the possible complications of celiac disease.

Malabsorption

When the body has no ability to absorb the nutrients from food, it will lead to malabsorption. This can lead to some vitamin and mineral deficiencies. As a result, certain conditions may emerge including vitamin B2 deficiency anemia, folate deficiency anemia, iron deficiency anemia, and osteoporosis.

Malnutrition

The damage to the small intestine means that the digestive system works less effectively. The small intestines can’t absorb enough nutrients, which may lead to malnutrition. This condition may lead to weight loss and anemia. In kids, it could lead to impaired growth and short stature.

Lactose Intolerance

People with celiac disease are more likely to develop lactose intolerance. In this condition, the body lacks the enzyme to digest lactose, a milk sugar. This condition may lead to symptoms like bloating, abdominal pain, gas, and diarrhea.

Loss of Bone Density

Malabsorption of Vitamin D and calcium may lead to osteomalacia or rickets, a condition characterized by the softening of the bones. The loss of bone density is termed as osteoporosis in adults.

Cancer

Some studies have shown that celiac disease increases the risk of certain cancers such as colorectal cancer and lymphoma, a cancer of the lymphatic system which is a part of the immune system.

Infertility and Miscarriage

Celiac disease in pregnancy may cause complications too. Malabsorption of vitamin D and calcium may also lead to infertility and miscarriage. Moreover, prolonged celiac disease during pregnancy may lead to complications like giving birth to a low birth weight baby.

Neurological Problems

Some individuals with celiac disease may develop some neurological problems like peripheral neuropathy and seizures.

6Diagnosis

There are some people who need to be screened for celiac disease. However, researchers found that only 20 percent of those with celiac disease receive a diagnosis. The people who should be screened include:

  • Children that are three years old and above and adults who are experiencing the symptoms of celiac disease.
  • Immediate family members of those who have a celiac diseases such as parents, children, and siblings.
  • A person with an autoimmune disorder especially types 1 diabetes, autoimmune liver disease, Down syndrome, Turner syndrome, Williams syndrome, autoimmune thyroid disease, autoimmune liver disease and selective immunoglobulin A (IgA) deficiency.

Screening

There are various ways to screen or test for celiac disease.

Blood or Serology Test – This is a diagnostic test to determine people who may have celiac disease. This test will determine the presence of antibodies in the blood. When there are elevated levels of antibody proteins, it may signal the presence of an immune reaction to gluten.

Genetic Testing – Another way to determine a person with an increased risk of celiac disease, is through genetic testing.

Biopsy – This is tissue sample testing to confirm the diagnosis. This procedure can be done through endoscopy to view the small intestines and take a tissue sample.

7Treatment

Today, a 100 percent gluten-free diet is the only existing treatment option for celiac disease. This means a lifelong adherence to a strict gluten-free diet which has no wheat, rye, and barley.

Here are the foods to avoid:

  • Barley
  • Durum
  • Bulgur
  • Farina
  • Malt
  • Malt
  • Graham flour
  • Rye
  • Spelt
  • Semolina
  • Triticale

Foods that contain gluten, unless they’re labeled gluten-free

  • Pasta
  • Bread
  • Cereals
  • Crackers
  • Biscuits
  • Cakes
  • Pastries
  • Pies
  • Sauces and Gravies

Foods That DO NOT Contain Gluten:

  • Most dairy products like milk, butter, and cheese
  • Potatoes
  • Meat and fish, as long as they’re not battered or breaded
  • Rice and rice noodles
  • Fruits and vegetables
  • Gluten-free flour like rice, corn, soy, and potato

Other Treatments:

Vaccinations – Some individuals who have celiac disease are susceptible to infection because the spleen does not work effectively. Having vaccinated against some pathogens may help. Get shots for influenza, Hib/MenC vaccine to protect against sepsis, and pneumococcal vaccine.

Vitamin and Mineral Supplements – Since you can’t absorb much of the nutrients from food, it’s important to take vitamin and mineral supplements as prescribed by your doctor. You can take supplements of calcium, iron, folate, vitamin B12, vitamin K, vitamin D and zinc.

Medications for Intestinal Inflammation

Dermatitis Herpetiformis – For people with dermatitis herpetiformis, it may take longer to clear the rash and control other symptoms. In this case, the doctor may prescribe a medication to hasten the healing of the rash. A licensed doctor should only prescribe this drug called Dapsone.

Refractory celiac disease – People who have the refractory celiac disease may have severe symptoms after a relapse. This disease is serious because the symptoms of celiac disease continue even after switching to a gluten-free diet. Treatment for this condition includes steroids to reduce the harmful effects of the immune system and inflammation.