Information about Celiac Disease
People with celiac disease are sensitive to gluten, a component of wheat and other grains. The disorder was once thought to be rare in the United States, but research now shows that about one in 100 Americans has the disease. Many people don't know they have celiac disease, either because they or their doctor have attributed the symptoms to another illness or because they have no symptoms.
Causes and symptoms of celiac disease
Celiac disease is an autoimmune disorder (the body's immune system attacks itself) and a malabsorption disorder (nutrients from foods are not absorbed). Gluten, which is found in wheat and other grains, contains a protein called gliadin. In people with celiac disease, consuming gliadin produces an immune reaction that causes the villi (fingerlike projections in the intestines) to flatten or disappear. This decreases the ability of the villi to absorb nutrients from food.
As a result, diarrhea, bloating, weight loss, anemia, and vitamin deficiencies are common and are some of the first signs of the disorder. Eventually, long-term damage to the small intestine may result. Osteoporosis is common in people with celiac disease because of poor absorption of vitamin D and calcium.
Other possible symptoms related to poor nutrient absorption include fatigue and muscle or bone pain. Long-term malabsorption of nutrients can even damage the nerves, bones, teeth, pancreas, and liver. In addition, a type of cancer called lymphoma is six times more likely in people with celiac disease than in those without the condition.
Risk factors for celiac disease
Celiac disease is most common in whites and people of European ancestry. Seventy percent of cases occur in women. A family history of the disease is another important risk factor. As many as 10 percent of people with celiac disease have a close relative (a parent, child, or sibling) who also has the disease. If you have no close relatives with the disease, however, your risk of celiac disease is less than 1 percent.
Screening and diagnosis of celiac disease
Many people have celiac disease for years but do not know it because they don't have the most common symptoms—diarrhea, bloating, gas, and weight loss—or they have no symptoms at all. Celiac disease is especially difficult to diagnose in older adults because they are more likely to have non-specific symptoms (for instance, pain in the joints or numbness in the legs) or nutritional deficiencies because of their age or other health problems. The good news, however, is that being diagnosed at an older age usually means the course of the disease will be relatively mild compared with people who are diagnosed at an early age.
If you have a close relative with celiac disease, you should be screened for the condition with a blood test. Screening should also be considered if you have thyroid disease or type 1 diabetes, unexplained digestive symptoms, or weight loss. The blood test measures three specific antibodies that are present when a person with celiac disease ingests gluten. If these three antibodies are found, a biopsy of the small intestine is usually performed to look for damaged villi.
The biopsy involves inserting an endoscope down the throat, through the stomach, and into the small intestine. It is important not to avoid foods that contain gluten before these tests, since avoidance could make blood test and biopsy results appear normal and prevent an accurate diagnosis.
Screening for celiac disease may also involve a blood test and a skin biopsy for dermatitis herpetiformis (DH), an itchy, blistering rash occurring in up to 25 percent of people with celiac disease.