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Celiac Disease

Celiac disease is a condition characterized by sensitivity to gluten, a protein contained in wheat, rye, and barley. The small intestine is damaged by its own inflammatory reaction to gluten. The inflammation damages the cells lining the small intestine, changing them from their normal state of long projections (called villi) to a state where the villi are flattened. As a result, there is less surface area to absorb nutrients, leading to poor absorption (malabsorption) of nutrients.

WHAT CAUSES CELIAC DISEASE?

Celiac disease occurs in people who are genetically susceptible to the disease and are exposed to gluten.

SYMPTOMS OF CELIAC DISEASE

The most common symptoms of celiac disease are diarrhea and unexplained weight loss. Many patients with celiac disease do not have digestive symptoms or any symptoms at all. Such patients are diagnosed when they present with anemia, osteoporosis or other conditions associated with celiac disease. Less than half of patients with celiac disease have diarrhea and unexplained weight loss. Other symptoms include:

  • Bloating;
  • Loss of bone leading to bone fractures (osteoporosis);
  • Dermatitis herpetiformis (an itchy, blistery skin rash);
  • Headaches and fatigue;
  • Joint pains;
  • Mouth sores;
  • Infertility;
  • Reduced functioning of the spleen (hyposplenism).

CELIAC DISEASE DIAGNOSIS

Someone suspected of having celiac disease should be tested before attempting to relieve symptoms through a gluten-free diet. The test results may become normal if the patient stops eating gluten before the test is performed.

  • Blood tests: to check for A) the typical genes involved in celiac disease (HLA DQ2/DQ8), and B) specific antibodies indicating an immune reaction to gluten. Blood tests alone are not sufficient for diagnosis.
  • Upper endoscopy with biopsies. This test is absolutely necessary to establish a diagnosis.

CELIAC DISEASE DIET

The cornerstone of the treatment of celiac disease is the elimination of gluten in the diet. The gastroenterologist will refer the patient to a dietitian for instruction on adopting gluten-free diet. There are several celiac disease patient associations and other organization which offer valuable resources (www.americanceliac.org, www.celiac.org, www.celiacawareness.org)

Other recommendations include:

  • Monitoring for malabsorption and providing deficient nutrients;
  • Monitoring and prevention of bone loss;
  • Pneumococcal vaccination;
  • Screening of first-degree relatives.
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