What is
celiac disease?
Celiac disease is a digestive disease that damages the small
intestine and interferes with absorption of nutrients from food.
People who have celiac disease cannot tolerate gluten, a protein
in wheat, rye, and barley. Gluten is found mainly in foods but may
also be found in everyday products such as medicines, vitamins,
and lip balms.
When people with celiac disease eat foods or use products
containing gluten, their immune system responds by damaging or
destroying villi the tiny, fingerlike protrusions lining the small
intestine. Villi normally allow nutrients from food to be absorbed
through the walls of the small intestine into the bloodstream.
Without healthy villi, a person becomes malnourished, no matter
how much food one eats.
Celiac disease is both a disease of malabsorption meaning
nutrients are not absorbed properly and an abnormal immune
reaction to gluten. Celiac disease is also known as celiac sprue,
nontropical sprue, and gluten-sensitive enteropathy. Celiac
disease is genetic, meaning it runs in families. Sometimes the
disease is triggered or becomes active for the first time after
surgery, pregnancy, childbirth, viral infection, or severe
emotional stress.
What are the symptoms of celiac disease?
Symptoms of celiac disease vary from person to person. Symptoms
may occur in the digestive system or in other parts of the body.
Digestive symptoms are more common in infants and young children
and may include
abdominal bloating and pain
chronic diarrhea
vomiting
constipation
pale, foul-smelling, or fatty stool
weight loss
Irritability is another common symptom in children. Malabsorption
of nutrients during the years when nutrition is critical to a
child’s normal growth and development can result in other problems
such as failure to thrive in infants, delayed growth and short
stature, delayed puberty, and dental enamel defects of the
permanent teeth.
Adults are less likely to have digestive symptoms and may instead
have one or more of the following:
unexplained iron-deficiency anemia
fatigue
bone or joint pain
arthritis
bone loss or osteoporosis
depression or anxiety
tingling numbness in the hands and feet
seizures
missed menstrual periods
infertility or recurrent miscarriage
canker sores inside the mouth
an itchy skin rash called dermatitis herpetiformis
People with celiac disease may have no symptoms but can still
develop complications of the disease over time. Long-term
complications include malnutrition which can lead to anemia,
osteoporosis, and miscarriage, among other problems liver
diseases, and cancers of the intestine.
Why are celiac disease symptoms so
varied?
Researchers are studying the reasons celiac disease affects people
differently. The length of time a person was breastfed, the age a
person started eating gluten-containing foods, and the amount of
gluten-containing foods one eats are three factors thought to play
a role in when and how celiac disease appears. Some studies have
shown, for example, that the longer a person was breastfed, the
later the symptoms of celiac disease appear.
Symptoms also vary depending on a person’s age and the degree of
damage to the small intestine. Many adults have the disease for a
decade or more before they are diagnosed. The longer a person goes
undiagnosed and untreated, the greater the chance of developing
long-term complications.
What other health problems do people with
celiac disease have?
People with celiac disease tend to have other diseases in which
the immune system attacks the body’s healthy cells and tissues.
The connection between celiac disease and these diseases may be
genetic. They include
type 1 diabetes
autoimmune thyroid disease
autoimmune liver disease
rheumatoid arthritis
Addison’s disease, a condition in which the glands that produce
critical hormones are damaged
Sjögren’s syndrome, a condition in which the glands that produce
tears and saliva are destroyed
How common is celiac disease?
Celiac disease affects people in all parts of the world.
Originally thought to be a rare childhood syndrome, celiac disease
is now known to be a common genetic disorder. More than 2 million
people in the United States have the disease, or about 1 in 133
people.1 Among people who have a first-degree relative a parent,
sibling, or child diagnosed with celiac disease, as many as 1 in
22 people may have the disease.2
Celiac disease is also more common among people with other genetic
disorders including Down syndrome and Turner syndrome, a condition
that affects girls’ development.
How is celiac disease treated?
The only treatment for celiac disease is a gluten-free diet.
Doctors may ask a newly diagnosed person to work with a dietitian
on a gluten-free diet plan. A dietitian is a health care
professional who specializes in food and nutrition. Someone with
celiac disease can learn from a dietitian how to read ingredient
lists and identify foods that contain gluten in order to make
informed decisions at the grocery store and when eating out.
For most people, following this diet will stop symptoms, heal
existing intestinal damage, and prevent further damage.
Improvement begins within days of starting the diet. The small
intestine usually heals in 3 to 6 months in children but may take
several years in adults. A healed intestine means a person now has
villi that can absorb nutrients from food into the bloodstream.
To stay well, people with celiac disease must avoid gluten for the
rest of their lives. Eating even a small amount of gluten can
damage the small intestine. The damage will occur in anyone with
the disease, including people without noticeable symptoms.
Depending on a person’s age at diagnosis, some problems will not
improve, such as short stature and dental enamel defects.
Some people with celiac disease show no improvement on the
gluten-free diet. The most common reason for poor response to the
diet is that small amounts of gluten are still being consumed.
Hidden sources of gluten include additives such as modified food
starch, preservatives, and stabilizers made with wheat. And
because many corn and rice products are produced in factories that
also manufacture wheat products, they can be contaminated with
wheat gluten.
Rarely, the intestinal injury will continue despite a strictly
gluten-free diet. People with this condition, known as refractory
celiac disease, have severely damaged intestines that cannot heal.
Because their intestines are not absorbing enough nutrients, they
may need to receive nutrients directly into their bloodstream
through a vein, or intravenously. Researchers are evaluating drug
treatments for refractory celiac disease.
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