Coeliac disease or celiac disease is a long-term autoimmune disorder that primarily affects the small intestine. Classic symptoms include gastrointestinal problems such as chronic diarrhea, abdominal distention, malabsorption, loss of appetite and among children’s failure to grow normally.
This often begins between six months and two years of age. Non-classic symptoms are more common, especially in people older than two years. There may be mild or absent gastrointestinal symptoms, a wide number of symptoms involving any part of the body or no obvious symptoms.
Coeliac disease was first described in childhood; however, it may develop at any age. It is associated with other autoimmune diseases, such as diabetes mellitus type 1 and thyroiditis, among others.
Coeliac disease is caused by a reaction to gluten, a group of various proteins found in wheat and in other grains such as barley and rye. Moderate quantities of oats, free of contamination with other gluten-containing grains, are usually tolerated.
The occurrence of problems may depend on a variety of oat. It occurs in people who are genetically predisposed. Upon exposure to gluten, an abnormal immune response may lead to the production of several different autoantibodies that can affect a number of different organs.
In the small bowel, this causes an inflammatory reaction and may produce a shortening of the villi lining the small intestine (villous atrophy). This affects the absorption of nutrients, frequently leading to anemia.
Diagnosis is typically made by a combination of blood antibody tests and intestinal biopsies, helped by specific genetic testing. Making the diagnosis is not always straightforward. Frequently, the autoantibodies in the blood are negative, and many people have only minor intestinal changes with normal villi.
People may have severe symptoms and be investigated for years before a diagnosis is achieved. Increasingly, the diagnosis is being made in people without symptoms, as a result of screening. Evidence regarding the effects of screening, however, is not sufficient to determine its usefulness. While the disease is caused by permanent intolerance to gluten proteins, it is distinct from a wheat allergy, which is much rarer.
Celiac Disease Symptoms
Celiac disease is a permanent disorder. Symptoms can range from mild to severe, they can change over time, and they can vary between individuals. Some people may have no symptoms, or symptoms may not appear until later in life.
Some common symptoms of celiac disease include:
- Gastrointestinal symptoms, such as abdominal cramps, diarrhea, gas, nausea and vomiting, and bloating
- Foul-smelling stools with excess fat in them
- Bone and joint pain
- Depression, irritability, and panic attacks
- Weakness and fatigue
- Easy bruising and nose bleeds
- Fluid retention
- Persistent hunger
- Iron-deficiency anemia
- Malnutrition and nutrition deficiencies, including a lack of vitamin B12, D, and K
- Mouth sores and tooth discoloration
- Muscle wasting, muscle weakness, and muscle cramps
- Nerve damage, leading to tingling in the legs and feet
- Blood in the stools or in the urine
- Migraine headaches
Some people develop a type of skin rash known as dermatitis herpetiformis (DH). Red, raised patches, and blistering may affect the elbows, knees, shoulders, buttocks, and face.
Celiac disease can lead to malabsorption and malnutrition, damage to the large intestine, and subtle damage to other organs.
Many adults with mild symptoms experience fatigue and anemia, or possibly only vague abdominal discomforts, such as bloating, abdominal distention, and excess gas. Some people have no clear signs of disease, but a general feeling of being unwell.
Variations in symptoms may depend on:
- The length of time a person was breastfed, as symptoms tend to appear later in those who were breastfed for longer
- The amount of gluten consumed
- The age at which a person starts eating gluten
- The level of damage to the small intestine
People with celiac disease may be at higher risk of neuropathy, according to a study trusted Source published in JAMA Neurology.
Stress and anxiety may bring on symptoms.
Symptoms in infants and children
In children and infants, there may be intestinal problems, such as diarrhea, irritability, and failure to thrive, or delayed development.
In time, children may experience weight loss, damage to tooth enamel, and delayed puberty.
Celiac Disease Causes
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 gut bacteria might contribute, as well. Sometimes celiac disease becomes active 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, hairlike 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.
Celiac Disease 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
Celiac Disease Complications
Untreated, celiac disease can cause:
- Malnutrition. This occurs if your small intestine can’t 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 a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteopenia or osteoporosis) in adults.
- Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.
- Lactose intolerance. Damage to your small intestine might cause you abdominal pain and diarrhea after eating or drinking dairy products that contain lactose. Once your intestine has healed, you might be able to tolerate dairy products again.
- 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.
- Nervous system problems. Some people with celiac disease can develop problems such as seizures or a disease of the nerves to the hands and feet (peripheral neuropathy).
Nonresponsive celiac disease
Some people with celiac disease don’t respond to what they consider to be a gluten-free diet. Nonresponsive celiac disease is often due to contamination of the diet with gluten. Working with a dietitian can help you learn how to avoid gluten.
People with nonresponsive celiac disease might have:
- Bacteria in the small intestine (bacterial overgrowth)
- Microscopic colitis
- Poor pancreas function (pancreatic insufficiency)
- Irritable bowel syndrome
- Difficulty digesting the sugar found in dairy products (lactose), table sugar (sucrose), or a type of sugar found in honey and fruits (fructose)
- Refractory celiac disease
Refractory celiac disease
In rare instances, the intestinal injury of celiac disease doesn’t respond to a strict gluten-free diet. This is known as refractory celiac disease. If you still have signs and symptoms after following a gluten-free diet for six months to one year, you might need further testing to look for other explanations for your symptoms.
Celiac Disease Diagnosis
The doctor will examine the patient and ask about signs and symptoms, and they may request some tests.
Blood tests may detect:
- Antigliadin antibodies
- Endomysial antibodies
- Anti-tissue transglutaminase antibodies
Blood is screened for antibodies against deamidated gliadin peptide (TTG) and sometimes antigliadin (AGA) and endomysium antibodies (EmA).
A small intestinal biopsy is considered the most accurate test for celiac disease. The doctor uses endoscopy to take samples of the intestinal lining. Usually, several samples are obtained to increase the accuracy of the diagnosis.
Conditions that have similar symptoms to the celiac disease include:
- Pancreatic insufficiency
- Crohn’s disease of the small intestine
- Irritable bowel syndrome
- Small intestinal overgrowth of bacteria
- Gluten sensitivity, which has similar, but milder symptoms and is being debated as an entity
The doctor should eliminate these possibilities when making a diagnosis.
Celiac Disease Treatment
Scientists are investigating medications that work directly in the intestines, treatments that affect the immune system, and vaccinations to treat celiac disease.
However, there is currently no treatment, except for avoiding gluten.
If the individual continues to consume gluten, this can affect their quality of life, and it may increase the risk of some medical conditions.
Hair loss, anemia, and osteoporosis can occur because the body does not absorb nutrients effectively. Small bowel ulcers may develop.
Celiac disease has been linked to trusted Source certain types of cancer, including intestinal lymphoma and adenocarcinoma of the small intestine, of the pharynx, and of the esophagus.
In rare cases, refractory disease may occur, if action is not taken to manage celiac disease. This most commonly happens because it is difficult to maintain a fully gluten-free diet.
In people with refractory disease, the condition has been present for so long that the intestines are no longer able to heal on diet alone, and a gluten-free diet will not help.
Medications, such as corticosteroids and immunosuppressive drugs, may be prescribed.
Children with celiac disease
Left untreated, childhood celiac disease can result in small height in adulthood, but a child with celiac disease who switches to a gluten-free diet often starts to grow in height and recover any delay caused by the disorder. Intestinal damage begins to heal within weeks of removing gluten from the diet.
As time goes by, children may experience spontaneous remissions and remain free of the signs and symptoms of celiac disease until later in life, but symptoms can later reappear.
Frequently Asked Questions About Celiac Disease
Can celiac disease kill you?
In the vast majority of cases, celiac disease is not fatal in the way we normally think of fatal diseases—it won’t progress and ultimately kill you.
How do you test for celiac disease?
Two blood tests can help diagnose it: 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.
Do potatoes have gluten?
Potatoes are gluten-free. Gluten is a type of protein found in wheat, rye, barley, and other grains. Potatoes aren’t grains, they’re a type of starchy vegetable. That’s good news for people who can’t tolerate gluten because they have celiac disease or gluten intolerance.
What does a celiac attack feel like?
The symptoms a person with celiac disease may experience after being “glutened” can vary, but for the average person, it goes something like this: Almost immediately after the gluten is consumed, the reactions begin, often as a feeling of becoming flushed with a drop in blood pressure.
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