Coeliac Disease | Celiac Disease

Snippet: Coeliac Disease | Celiac Disease article covers all

the topics of the disease like Symptoms, Treatment,
Diagnosis, Diet, Definition, etc.,

If you are suffering from Diarrhea, Weight loss, Abdominal or any

other discomfort when you eat food containing gluten, then it
may be Coeliac Disease. Checkout this article to know more
about this article. Coeliac Disease | Celiac Disease article
covers all the topics of the disease like Symptoms, Treatment,
Diagnosis, Diet, Definition, etc.,

1. About

Celiac disease (gluten-sensitive enteropathy), sometimes called

sprue or coeliac, is an immune reaction to eating gluten, a protein
found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune

response in your small intestine. Over time, this reaction
damages your small intestine's lining and prevents absorption of
some nutrients (malabsorption). The intestinal damage often
causes diarrhea, fatigue, weight loss, bloating and anemia, and
can lead to serious complications.

In children, malabsorption can affect growth and development, in

addition to the symptoms seen in adults.

There's no cure for celiac disease — but for most people,

following a strict gluten-free diet can help manage symptoms and
promote intestinal healing.

2. Symptoms
The signs and symptoms of celiac disease can vary greatly and
are different in children and adults. The most common signs for
adults are diarrhea, fatigue and weight loss. Adults may also
experience bloating and gas, abdominal pain, nausea,
constipation, and vomiting.

However, more than half of adults with celiac disease have signs
and symptoms that are not related to the digestive system.

2.1. Celiac Disease Symptoms In Adults

• Anemia, usually resulting from iron deficiency
• Loss of bone density (osteoporosis) or softening of bone
(osteomalacia)
• Itchy, blistery skin rash (dermatitis herpetiformis)
• Damage to dental enamel
• Mouth ulcers
• Headaches and fatigue
• Nervous system injury, including numbness and tingling in
the feet and hands, possible problems with balance, and
cognitive impairment
• Joint pain
• Reduced functioning of the spleen (hyposplenism)
• Acid reflux and heartburn
2.2. Celiac Disease Symptoms In Children

In children under 2 years old, typical signs and symptoms of

celiac disease include:

• Vomiting
• Chronic diarrhea
• Swollen belly
• Failure to thrive
• Poor appetite
• Muscle wasting
• Older children may experience:
 • Diarrhea
• Constipation
• Weight loss
• Irritability
• Short stature
• Delayed puberty
• Neurological symptoms, including attention-
deficit/hyperactivity disorder (ADHD), learning disabilities,
headaches, lack of muscle coordination and seizures

3. When to see a doctor

Consult your doctor if you have diarrhea or digestive discomfort

that lasts for more than two weeks. Consult your child's doctor if
your child is pale, irritable or failing to grow or has a potbelly and
foul-smelling, bulky stools.

Be sure to consult your doctor before trying a gluten-free diet. If

you stop or even reduce the amount of gluten you eat before
you're tested for celiac disease, you may change the test results.

Celiac disease tends to run in families. If someone in your family

has the condition, ask your doctor if you should be tested. Also
ask your doctor about testing if you or someone in your family
has a risk factor for celiac disease, such as type 1 diabetes.

4. Causes

Celiac disease occurs from an interaction between genes, eating

foods with gluten and other environmental factors, but the
precise cause isn't known. Infant feeding practices,
gastrointestinal infections and gut bacteria might contribute to
developing celiac disease.

Sometimes celiac disease is triggered — or becomes active for

the first time — after surgery, pregnancy, childbirth, viral
infection or severe emotional stress.

When the body's immune system overreacts to gluten in food, the

reaction damages the tiny, hair-like projections (villi) that line the
small intestine. Villi absorb vitamins, minerals and other nutrients
from the food you eat. If your villi are damaged, you can't get
enough nutrients, no matter how much you eat.

Some gene variations appear to increase the risk of developing

the disease. But having those gene variants doesn't mean you'll
get celiac disease, which suggests that additional factors must be
involved.

The rate of celiac disease in Western countries is estimated at

about 1 percent of the population. Celiac disease is most common
in Caucasians; however, it is now being diagnosed among many
ethnic groups and is being found globally.

5. Risk Factors

Celiac disease can affect anyone. However, it 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
• Rheumatoid arthritis

6. Complications

Untreated, celiac disease can cause:

6.1. Malnutrition

The damage to your small intestine means it can't absorb enough

nutrients. Malnutrition can lead to anemia and weight loss. In
children, malnutrition can cause slow growth and short stature.

6.2. Loss Of Calcium And Bone Density

Malabsorption of calcium and vitamin D may lead to a softening

of the bone (osteomalacia or rickets) in children and a loss of
bone density (osteoporosis) in adults.

6.3. Infertility And Miscarriage

Malabsorption of calcium and vitamin D can contribute to

reproductive issues.

6.4. Lactose Intolerance

Damage to your small intestine may cause you to experience

abdominal pain and diarrhea after eating lactose-containing dairy
products, even though they don't contain gluten. Once your
intestine has healed, you may be able to tolerate dairy products
again. However, some people continue to experience lactose
intolerance despite successful management of celiac disease.

6.5. Cancer

People with celiac disease who don't maintain a gluten-free diet

have a greater risk of developing several forms of cancer,
including intestinal lymphoma and small bowel cancer.

6.6. Neurological Problems

Some people with celiac disease may develop neurological

problems such as seizures or peripheral neuropathy (disease of
the nerves that lead to the hands and feet).

In children, celiac disease can also lead to failure to thrive,

delayed puberty, weight loss, irritability and dental enamel
defects, anemia, arthritis, and epilepsy.

7. Nonresponsive Celiac Disease

As many as 30 percent of people with celiac disease may not

have, or be able to maintain, a good response to a gluten-free
diet. This condition, known as nonresponsive celiac disease, is
often due to contamination of the diet with gluten. Therefore it's
important to work with a dietitian.

People with nonresponsive celiac disease may have additional

conditions, such as bacteria in the small intestine (bacterial
overgrowth), microscopic colitis, poor pancreas function,
irritable bowel syndrome or intolerance to disaccharides (lactose
and fructose). Or, they may have refractory celiac disease.
 8. Refractory Celiac Disease

In rare instances, the intestinal injury of celiac disease persists

and leads to substantial malabsorption, even though you have
followed a strict gluten-free diet. This combination is known as
refractory celiac disease.

If you continue to experience signs and symptoms despite

following a gluten-free diet for six months to one year, your
doctor may recommend further testing and look for other
explanations for your symptoms. Your doctor may recommend
treatment with a steroid to reduce intestinal inflammation, or a
medication that suppresses your immune system. All patients
with celiac disease should be followed up to monitor the response
of their disease to treatment.

9. Diagnosis

Researchers estimate that only 20 percent of people with celiac

disease may receive a diagnosis.

Doctors may order two blood tests to help diagnose celiac

disease.

Serology testing looks for antibodies in your blood. Elevated

levels of certain antibody proteins indicate an immune reaction to
gluten.

Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-

DQ8) can be used to rule out celiac disease.
If the results of these tests indicate celiac disease, your doctor
may order an endoscopy to view your small intestine and to take
a small tissue sample (biopsy) to analyze for damage to the villi.

It's important to be tested for celiac disease before trying a

gluten-free diet. Eliminating gluten from your diet may change
the results of blood tests so that they appear to be normal.

10. Treatment

A strict, lifelong gluten-free diet is the only way to manage celiac

disease. In addition to wheat, foods that contain gluten include:

• Barley
• Bulgur
• Durum
• Farina
• Graham flour
• Malt
• Rye
• Semolina
• Spelt (a form of wheat)
• Triticale

Your doctor may refer you to a dietitian, who can help you plan a
healthy gluten-free diet.

Once you remove gluten from your diet, inflammation in your

small intestine generally begins to lessen — usually within several
weeks, though you may start to feel better in just a few days.
Complete healing and regrowth of the villi may take several
months to several years. Healing in the small intestine tends to
occur more quickly in children than adults.
If you accidentally eat a product that contains gluten, you may
experience abdominal pain and diarrhea. Some people
experience no signs or symptoms after eating gluten, but this
doesn't mean it's not harmful to them. Even trace amounts of
gluten in your diet can be damaging, whether or not they cause
signs or symptoms.

Hidden gluten can be present in foods, medications and nonfood

products, including:

• Modified food starch, preservatives and food stabilizers

• Prescription and over-the-counter medications
• Vitamin and mineral supplements
• Herbal and nutritional supplements
• Lipstick products
• Toothpaste and mouthwash
• Envelope and stamp glue
• Play-Doh
• Vitamin and mineral supplements

If your nutritional deficiencies are severe, your doctor or

dietitian may recommend taking vitamin and mineral
supplements. You may need to supplement your levels of:

• Calcium
• Folate
• Iron
• Vitamin B-12
• Vitamin D
• Vitamin K
 • Zinc

Vitamins and supplements are usually taken in pill form. If your

digestive tract has trouble absorbing vitamins, your doctor may
give them by injection. You need to be sure that the vitamins and
supplements are gluten-free.

11. Follow-Up Care

If you have celiac disease, you will need medical follow-up to

make sure your symptoms have responded to a gluten-free diet.
Doctors will also want to be sure you are getting the support you
need to maintain the diet for life. They will use blood tests to
monitor your response. The results of these tests, which are
primarily designed as a way to detect celiac disease, usually
become negative once you have been gluten-free for six to 12
months. If test results remain positive, then your doctor may try
to find the reason, the most common being unintentional
exposure to gluten in your diet.

However, these tests are not perfect, and even if the results
become negative, it is possible that you could still be exposed to
a significant amount of gluten and continue to have symptoms
and damage to your intestines.

If you continue to have symptoms, or your symptoms recur, you

may need a follow-up endoscopy with biopsies to ensure that
healing has occurred. Adults typically have a greater need for
follow-up testing, although children may require it, too. Some
doctors recommend a routine re-biopsy if you are diagnosed in
adulthood, as healing is often quite slow and uncertain.
It also can be helpful to follow up with an expert dietitian for
assistance in adapting to, and maintaining, a healthy, nutritious,
gluten-free diet.

11.1. Medications To Control Intestinal Inflammation

If your small intestine is severely damaged, your doctor may

recommend steroids to control inflammation. Steroids can ease
severe signs and symptoms of celiac disease while the intestine
heals.

11.2. Dermatitis Herpetiformis

If you have this itchy, blistering skin rash that sometimes

accompanies celiac disease, your doctor may recommend a skin
medication (dapsone) along with the gluten-free diet.

11.3. Refractory Celiac Disease

If you have refractory celiac disease, you may continue to have

severe symptoms, or your symptoms may lessen but then
relapse. In either case, your small intestine does not heal. When
this happens, you likely will require evaluation in a specialized
center. Refractory celiac disease can be quite serious and there is
currently no proven treatment.

People with refractory celiac disease should be treated by

experts. There may be several causes for this condition. Doctors
will often use steroid therapy — either a topical budesonide or
systemic steroids such as prednisone. Sometimes, they will use
the same medications used to treat other conditions.

11.4. Potential Future Treatments

While the only proven therapy for celiac disease is a gluten-free

diet, it is not perfect. People with celiac disease may often be
accidentally exposed to gluten, possibly causing severe
symptoms.

Several treatments are in development for celiac disease. Some

try to neutralize or bind to gluten. Others address the barrier of
the intestine, blocking the leakiness that gluten can trigger. Still
others target the body's immune system. Researchers have also
been trying to genetically modify wheat, but have not yet been
successful.

None of these treatments is likely to be approved within the next

two to three years. However, given the number of different
approaches, there is a good chance that there will be additional
treatments available for celiac disease in the future.

12. Lifestyle And Home Remedies

If you've been diagnosed with celiac disease, you'll need to avoid

all foods that contain gluten. Ask your doctor for a referral to a
dietitian, who can help you plan a healthy gluten-free diet. It's
important to get enough vitamins, nutrients, fiber and calcium in
your diet.

Here's an overview of foods that contain gluten and gluten-free

foods that are safe to eat.

12.1. Always Avoid

Avoid food and drinks containing:

• Barley
• Bulgur
• Durum
• Farina
• Graham flour
• Malt
• Rye
• Semolina
• Spelt (a form of wheat)
• Triticale
• Wheat
12.2. Read Labels

Packaged foods should be avoided unless they're labeled as

gluten-free or have no gluten-containing ingredients. In addition
to cereals, pastas and baked goods — such as breads, cakes, pies
and cookies — other packaged foods that may contain gluten
include:

• Beer
 • Candies
• Gravies
• Imitation meats or seafood
• Processed luncheon meats
• Salad dressings and sauces, including soy sauce
• Self-basting poultry
• Soups

Certain grains, such as oats, can be contaminated with wheat

during growing and processing. Pure oats are not harmful for
most people with celiac disease. In the United States, doctors
generally recommend avoiding oats unless they have been
specifically labeled gluten-free. Outside of the United States,
different labeling laws for oats apply. Occasionally, even pure
oats can be a problem for people with celiac disease.

12.3. Allowed Foods

Many basic foods are allowed in a gluten-free diet, including:

• Fresh meats, fish and poultry that aren't breaded, batter-

coated or marinated
• Fruits
• Most dairy products
• Potatoes
• Vegetables
• Wine and distilled liquors, ciders and spirits

Grains and starches allowed in a gluten-free diet include:

• Amaranth
 • Arrowroot
• Buckwheat
• Corn
• Cornmeal
• Gluten-free flours (rice, soy, corn, potato, bean)
• Pure corn tortillas
• Quinoa
• Rice
• Tapioca

Carob is a potential substitute for gluten, but more research is

needed about its effect on people with celiac disease.

Fortunately for bread and pasta lovers with celiac disease, an

increasing number of gluten-free products are available. If you
can't find any at your local bakery or grocery store, check online.
There are gluten-free substitutes for many gluten-containing
foods. However, be aware that processed gluten-free foods may
contain excessive fat and calories.

13. Alternative Medicine

There are no proven treatments that assist with celiac disease.

Enzyme therapies that claim to digest gluten may be available
in health food stores or other outlets, but there is no scientific
evidence that they are effective in treating celiac disease.

14. Coping And Support

It can be difficult, and stressful, to follow a completely gluten-free
diet. Here are some ways to help you cope and to feel more in
control.

Get educated: Educate those around you — including family and

friends — so they can recognize, acknowledge and support your
efforts in dealing with the disease.

Follow your doctor's recommendations: If you are diagnosed

with celiac disease, it's necessary to maintain a totally gluten-free
diet.

Find a support group: It's helpful to know that you're not

alone. You may find comfort in sharing your experience and
struggles and meeting people who face similar challenges.
Organizations such as the Celiac Disease Foundation, Gluten
Intolerance Group, the Celiac Support Association and Beyond
Celiac can help put you in touch with others who have had similar
experiences and can understand what you're going through.

14.1. Preparing For Your Appointment

You may be referred to a doctor who treats digestive diseases

(gastroenterologist).

Here's some information to help you prepare for your

appointment and know what to expect from your doctor.

14.2. What Can You Do

Continue eating a normal diet. If you stop or reduce eating
gluten before you're tested for celiac disease, you may change
the test results.

Write down your symptoms. Include when they started and how
they may have changed over time.

Write down key personal information. Include any major stresses

or recent life changes.

Make a list of all medications. Include vitamins or supplements

that you're taking.

Write down questions to ask your doctor.

Questions to ask your doctor

Some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?

Is my condition temporary or long term?

What kinds of tests do I need?

What treatments can help?

Are there any dietary restrictions that I need to follow?

How will I learn which foods contain gluten? Should I see a

dietitian?

If I have celiac disease, will you also test for other conditions
such as vitamin or mineral deficiencies, osteoporosis or diabetes?

Don't hesitate to ask other questions during your appointment.

 14.3. What To Expect From Your Doctor

Be ready to answer questions your doctor may ask:

When did you first begin experiencing symptoms, and how severe
are they?

Have your symptoms been continuous or occasional?

What, if anything, seems to improve your symptoms?

What, if anything, seems to worsen your symptoms?

What medications and pain relievers do you take?

Does anyone in your family have celiac disease?

Do you or does anyone in your family have an autoimmune

disorder?

Have you had any blistering or itchy skin rashes with your
symptoms?

Have you ever been diagnosed with anemia or osteoporosis?

15. Myths About Coeliac Disease

‘Coeliac disease is rare’...myth

Research shows that coeliac disease affects 1 in 100 people in the

UK, making it much more common than previously thought.
Under diagnosis is a big problem and research suggests around
500,000 people have not yet been diagnosed.

‘Coeliac disease is a food allergy’...myth

Coeliac disease is not a food allergy or an intolerance, it is an
autoimmune disease. In coeliac disease, eating gluten causes the
lining of the small intestine to become damaged. Other parts of
the body may be affected.

‘You have to have gut symptoms such as diarrhoea to have

coeliac disease’...myth

Coeliac disease is known as a 'multi-system' disorder - symptoms

can affect any area of the body. Symptoms differ between
individuals in terms of type and severity. Read more on
symptoms if coeliac disease.

‘Only children get coeliac disease’...myth

Coeliac disease can develop and be diagnosed at any age. It may

develop after weaning onto cereals that contain gluten, in old age
or any time in between. Coeliac disease is most frequently
diagnosed in people aged 40-60 years old. Delayed diagnosis is
common and our research shows the average time it takes to be
diagnosed is 13 years.

'You have to be underweight to have undiagnosed coeliac

disease’...myth

Recent research suggests that most people with coeliac disease

are of normal weight or overweight at diagnosis. Body weight
alone should not be used to decide whether or not you should be
tested for coeliac disease.
‘You can ‘grow out’ of having coeliac disease’...myth

Coeliac disease is a lifelong condition. The gluten-free diet is the

only treatment for coeliac disease. If gluten is introduced back
into the diet at a later date, the immune system will react and the
gut lining will become damaged again. If someone following a
gluten-free diet is retested for coeliac disease (antibody blood
test, gut biopsy) it would be expected that the tests are negative.
This means they are responding well to the gluten-free diet.
There are no antibodies in the blood because there is no gluten
for the immune system to react against. Taking gluten out of the
diet allows the gut to heal.

‘A breadcrumb won’t hurt someone with coeliac disease’...myth

Even very small amounts of gluten can be damaging to people

with coeliac disease. Therefore, taking sensible steps to avoid
cross contamination with gluten is important.

16. Top Tips

keep cooking utensils separate during food preparation and

cooking

avoid frying food in the same oil that has previously been used to
cook foods which contain gluten

use a clean grill, separate toaster or toaster bags to make gluten-

free toast

use separate breadboards and wash surfaces thoroughly

use separate condiments like jam, butter, mustard and
mayonnaise.

‘Coeliac disease only affects people of European origin’...myth

Coeliac disease affects all ethnic groups and is common in Europe

and North America, as well as in southern Asia, the Middle East,
North Africa and South America.

17. References

1. https://www.mayoclinic.org/

2. https://www.coeliac.org.uk