Celiac disease is a condition of the gastrointestinal tract that results in the inability to properly digest a protein known as gluten. Gluten is found in certain grains: wheat, rye, barley and oats. An individual will have an immunological reaction to gluten, causing irritation and damage to the lining of the small intestine. This damage will cause the small intestine to be unable to fully absorb specific nutrients.
Considered an autoimmune disease, Celiac disease is also referred to as sprue, nontropical sprue and gluten sensistive entropy. There is a genetic link to this disease. Failure of the body to absorb nutrients creates a vitamin deficiency that can lead to other serious illnesses. This is a particular concern in children who are developing rapidly.
There is no cure for celiac disease, but it can be controlled and intestinal damage avoided through a proper diet that is gluten free.
Symptoms for celiac disease vary depending on the stage of the disease. The most common symptoms are bloating, irregular bouts of diarrhea, and abdominal pain. These symptoms mimic other diseases such as parasite infections, anemia, gastric ulcers and irritable bowel syndrome. Unspecific symptoms can also occurs such as skin rash, mouth sours, dental and bone disorders, depression, irritability, stomach cramping and neuropathy – a tingling in the legs and arms.
Dermatitis herpetiformis is a skin rash that is always associated with gluten intolerance, whether the gluten intolerance is allergic or celiac disease is determined at diagnosis.
Malabsorption can occur with celiac disease and the symptoms are diarrhea, cramps, gas, bloating, weakness, foul-smelling, gray stools, stunted growth, osteoporosis, and weight loss. Five percent of patients initially diagnosed with irritable bowel syndrome actually have celiac disease.
Untreated celiac disease can lead to adenocarcinoma and lymphoma of the small bowel. Adenocarcinoma is a cancer that begins in cells that line organs and has behaves like glands. In the case of celiac disease this cancer is of the gastrointestinal tract.
The first step in diagnosis celiac disease is usually a blood test. Blood levels of the antibodies anti-gliadin, anti-endomysium, and anti-tissue transglutaminase are elevated in celiac patients. Antibodies are proteins of the immune system; in this case the substance to be attacked is gluten. The elevated levels of the above antibodies indicate that the body is fighting gluten.
Confirming the diagnosis requires a small intestine biopsy. An intestinal biopsy is performed under general anesthesia in small children and sedation in adults. A small portion is removed from the intestine and examined under a microscope by a pathologist. This intestine portion is removed by snaking a small tube down throat and through the stomach to the intestine. The small intestines have villi which help with absorption of nutrients. Celiac disease will cause the villi to be damaged. This damage will be apparent under microscopic evaluation.
The small intestine is lined with tiny projections that look like hairs. These are villi and their function is to absorb vitamins, nutrients and minerals from ingested food. The lining of the small intestine begins to look cracked and damaged, causing the nutrients to be expelled through the digestive tract without absorption into the body.
The cause of celiac disease is not known. The disease is inherited; an individual that has a family member with celiac disease has an up to twenty percent chance of having the disease as well. It has been noted that the disease can appear spontaneously after a severe strain to the body such as physical injury, infection, pregnancy or surgery.
Even though there is no cure for celiac disease, the damage can be controlled and the intestine will heal itself. The key to controlling celiac disease is to have gluten free diet. Once gluten is eliminated the small intestine villi will heal and proper digestion will resume. If nutritional issues have occurred due to a progressive case of the disease, nutritional supplements may be prescribed.
Children with celiac disease, who begin the diet, experience the most rapid health improvements. Total healing of the villi of the small intestine can take up to three years.
Avoiding gluten takes a strong commitment and self-education about food ingredients. Gluten is found in barley, rye, bulgur, wheat, oats and many other grains. Even if a gluten free grain is used, cross-contamination can occur via procession on equipment used to process products containing gluten.
An easy list of basic foods allowed on the diet:
Fruit and vegetables
Dairy products (check the label)
Fresh meat, fish and chicken or poultry that is not breaded and marinated with gluten free products.
Common foods that contain gluten are:
Cakes and Pies
Sauces – including salad dressing
Gluten free foods are currently widely available. Any of the above foods can be purchased or made at home using gluten free ingredients. Manufacturers are required by law to list ingredients, but it is recommended to contact the company directly to determine if a food is truly gluten free.
A celiac patient that goes back to eating gluten can have abdominal pain and diarrhea. Some patients with celiac disease will have not symptoms after ‘cheating’; the damage to the small intestine occurs immediately, however. Switching back and forth from gluten to non-gluten diets can cause complications, which may become severe.
A small percentage of individuals with celiac disease have severely damaged intestines that do not heal with a gluten free diet. Treatment for this condition is designed to control inflammation of the affected intestines and aid in absorption of nutrients.
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