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Celiac Disease

Celiac disease is an autoimmune disorder of the gastrointestinal tract that is driven by exposure to dietary gluten. Gluten is a storage protein in barley, wheat, and rye and thus difficult to avoid. Once thought to be rare, studies estimate that up to one in 300 people may have a form of this disorder. This is not new; it is just now being diagnosed more frequently and with more certainty. It is rather common in North America and Europe, as well as with individuals with a European or Middle Eastern decent.

Celiac disease is inheritable and genetic and is characterized by chronic inflammation of the mucosa of the small intestine, which eventually causes the small areas in the intestine to atrophy. This in turn leads to malabsorption and noticeable symptoms. Celiac disease can run the gamut from being a minor inconvenience to severely affecting people, and may develop at any age. As with many autoimmune diseases, it is two to three times more common in women, and patients are more prone to developing celiac disease if they have other autoimmune diseases such as thyroid issues or diabetes.

Early on, celiac disease doesn't present a lot of specific symptoms. Diarrhea and flatulence are probably the most common two, but they are intermittent. As time passes, symptoms become more prominent, with abdominal pain, bloating, malabsorption, and significant discomfort, as well as possible fatigue and anemia. While iron deficiency, folate deficiency, weight loss, and some electrolyte abnormalities may occur during the course, generally both doctor and patient are led to diagnostic suspicion by relating it to foods they have eaten. Lactose intolerance is usually the number one suspected problem, but when withdrawal of milk products doesn't resolve the problem, celiac disease may be a likely suspect.

The diagnosis of celiac disease is made through the use of serologic blood tests, a biopsy of the small bowel on endoscopic exam, and reaction to the withdrawal of gluten-containing diet. As serologic testing doesn't always make the diagnosis definitive, biopsies are needed to confirm. Early in the disease neither test may be conclusive and experimental treatment of a gluten-free diet should be introduced.

So what is a gluten-free diet? Grains that must be avoided are wheat, barley, malt, and rye. This is no easy task, given these make up the majority of the typical American diet. The internet is an excellent resource for food lists that are gluten-free, and with much newer packaging, particularly in health food stores, gluten-free products are easier to find. However, this can get significantly more expensive and dining out is always an unknown. Meats, vegetables, fruits, and dairy products are gluten-free (making this one way to differentiate this from lactose intolerance). Generally, it is advised to get tested anyway, as conditions like irritable bowel syndrome, reflux, and flatulence improve with a gluten-free diet and a complete diagnosis by biopsy is necessary.

More than 90% of people with celiac disorder improve significantly with a gluten-free diet, but amenability is difficult and the control needed to monitor food intake consistently is not easy, especially in a convenience-oriented world. Those who continue to have problems even after dietary intervention should be referred to a gastroenterologist. The diagnosis may need to be reconsidered with additional testing and a more potent medication. Immune system modulators or corticosteroids may have to be instituted for relief and more adequate treatment.

Authored by Dr. Bob Goldstone, M.D.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.