Celiac disease

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. Gluten is found in any food that contains those grains, including:

• pasta
• torte
• breakfast cereals
• most types of bread
• certain types of sauces
• some ready meals.
  Also, most beers are brewed with barley.

Celiac disease is genetic. Blood tests can help your doctor diagnose the disease. Your doctor may also need to examine a small piece of tissue from your small intestine. The treatment is a gluten-free diet.

There is no cure for celiac disease, but following a gluten-free diet should help control symptoms and prevent long-term complications of the condition.

Even if you have mild symptoms, it is still advisable to change your diet because continuing to eat gluten can lead to serious complications. This can also happen if tests show you have some degree of celiac disease even though you have no obvious symptoms.

It is important to ensure that your gluten-free diet is healthy and balanced.

The increase in the range of gluten-free foods available in recent years has made it possible to follow a gluten-free diet that is both healthy and varied.

Symptoms and possible complications

Celiac disease affects each person differently. Symptoms can occur in the digestive system or elsewhere in the body. One person might have diarrhea and abdominal pain, while another person might be irritable or depressed. Irritability is one of the most common symptoms in children. Some people have no symptoms. In children, malabsorption can affect growth and development, as well as cause the symptoms seen in adults.

Left untreated, celiac disease can cause:

• Malnutrition. This occurs if your small intestine is unable to absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.
• Bone weakening. Malabsorption of calcium and vitamin D can lead to bone softening (osteomalacia or rickets) in children and bone density loss (osteopenia or osteoporosis) in adults.
• Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive problems.
• Lactose intolerance. Damage to the small intestine could cause abdominal pain and diarrhea after eating or drinking dairy products that contain lactose. Once your gut has healed, you may be able to tolerate dairy products again.
• Cancer. People with celiac disease who don’t follow a gluten-free diet have a higher risk of developing several forms of cancer, including bowel lymphoma and small bowel cancer.
• Nervous system problems. Some people with celiac disease may develop problems such as seizures or nerve disease in the hands and feet (peripheral neuropathy).

Frequency

Celiac disease is a condition that affects at least 1 in 100 people.

But some experts think this may be underestimated because milder cases may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS).

Reported cases of celiac disease are approximately 3 times higher in women than in men. It can develop at any age, although symptoms are more likely to develop:

• during infancy – between 8 and 12 months, although it can take several years before a correct diagnosis is made
• in late adulthood – between 40 and 60 years of age

People with certain conditions, including type 1 diabetes, autoimmune thyroid disease, Down syndrome and Turner syndrome, have an increased risk of getting celiac disease.

First-degree relatives (parents, siblings, and children) of people with celiac disease are also at increased risk of developing the condition.

Risk factors

Celiac disease tends to be more common in people who have:

• a family member with celiac disease or dermatitis herpetiformis
• type 1 diabetes
• Down syndrome or Turner syndrome
• autoimmune thyroid disease
• microscopic colitis (lymphocytic or collagenous colitis)
• Addison’s disease

Cause

Your genes combined with eating foods with gluten and other factors can contribute to celiac disease, but the precise cause isn’t known. Infant feeding practices, gastrointestinal infections and intestinal bacteria could also contribute. Sometimes celiac disease becomes active after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Treatments

Celiac disease is usually treated simply by excluding foods that contain gluten from the diet.

This prevents damage to the lining of the bowel (gut) and associated symptoms, such as diarrhea and stomach pain.

If you have celiac disease, you must give up all sources of gluten for life. Your symptoms will return if you eat gluten-containing foods and will cause long-term damage to your health.

When you are first diagnosed with celiac disease, you will be referred to a dietitian to help you adjust to your new gluten-free diet. They can also ensure that your diet is balanced and contains all the nutrients you need.

Symptoms should improve markedly within a few weeks of starting a gluten-free diet. However, it may take up to 2 years for your digestive system to fully heal.

In some people, celiac disease can make the spleen work less effectively, making you more vulnerable to infection. You may therefore need to have extra vaccinations, including:

• influenza;
• Vaccino Hib/MenC;
• pneumonia and meningitis;
• pneumococcal vaccine;

In addition to eliminating gluten from your diet, your GP or dietitian may also advise you to take vitamin and mineral supplements, at least for the first 6 months after diagnosis.

This will ensure you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anemia.

If you have dermatitis herpetiformis, cutting gluten out of your diet should fix it. However, sometimes it can take longer for a gluten-free diet to clear up the rash. In this case, medications may be prescribed to speed up the healing time of the rash.

Unresponsive celiac disease

Some people with celiac disease do not respond to what they consider a gluten-free diet. Unresponsive celiac disease is often due to contamination of the diet with gluten. Working with a dietitian can help you learn how to avoid all gluten.

People with unresponsive celiac disease may have:

• bacteria in the small intestine (bacterial overgrowth)
• microscopic colitis
• poor pancreatic function (pancreatic insufficiency)
• irritable bowel syndrome
• difficulty digesting sugar found in dairy products (lactose), table sugar (sucrose), or a type of sugar found in honey and fruit (fructose)

Refractory celiac disease

Refractory celiac disease is a rarer type of celiac disease in which symptoms continue, even after switching to a gluten-free diet. The reasons for this are unclear.

It is estimated that about 1 in 140 people with celiac disease will develop the refractory form of the condition.

If refractory celiac disease is suspected, it’s likely you’ll be referred for a battery of tests to make sure your symptoms aren’t caused by another condition.

If no other cause can be found and the diagnosis is confirmed, you will be referred to a specialist. Treatment options include steroid drugs (corticosteroids), such as prednisolone, which help block the harmful effects of the immune system.