Celiac disease - Symptoms, Diagnosis and treatment

We've probably heard of people who are allergic to gluten-containing products. They are more likely to be diagnosed with Celiac disease.

Celiac Disease (CD) is an autoimmune and digestive disorder that affects the small intestine. Eating foods with gluten content causes the disease.

What is Celiac disease?

Celiac disease is an immunologically mediated disease caused by gluten intolerance in genetically susceptible people. This results in mucosal inflammation and degeneration of the villi, which causes malabsorption.

The disease can be fatal in certain cases. Celiac disease can cause long-term digestive issues and prevent the body from getting all of the nutrients it requires. It can also affect organs other than the small intestine.

Celiac disease isn’t the same as wheat intolerance or gluten sensitivity. Gluten sensitivity can cause symptoms similar to Celiac disease, such as abdominal pain and fatigue. The small intestine is not damaged due to gluten sensitivity like Celiac disease.

Celiac disease can also be referred to as Celiac sprue, nontropical sprue or gluten-sensitive enteropathy.

Celiac disease symptoms in adults 

Celiac disease symptoms vary greatly. A person may experience multiple symptoms that may come and go. Symptoms manifest in the form of digestive issues or other symptoms if Celiac disease is present.

Diarrhoea 

Gluten causes inflammation in the small intestine in people with Celiac disease. This gives rise to damage to the gut lining and poor nutrient absorption, resulting in significant digestive discomfort and diarrhoea.

Fatigue 

Fatigue or extreme tiredness is a common symptom of undiagnosed Celiac disease. Few people have this as the only symptom.

The absorption of essential nutrients required for energy metabolism, like folic acid, iron and vitamin B₁₂, is hindered due to gut damage caused by Celiac disease.

Weight loss 

Weight loss usually occurs as a result of the body's immune response to gluten, which damages the small intestines. This interferes with nutrient absorption in the body, causing people to lose weight.

Bloating and gas

Bloating and gas occur because the small intestine is incapable of absorbing nutrients from food. The condition is common but is not severe.

Abdominal pain 

Gluten triggers an immune response in the body causing mild stomach or abdominal pain.

Nausea and vomiting 

Celiac disease is significant when nausea and vomiting occur within two hours of consuming gluten. This occurs due to the intestinal irritation caused by the disease.

Constipation 

The intestinal villi of a person with Celiac disease are damaged due to Celiac antibodies produced by gluten ingestion.

This reduces nutrient absorption from food as it passes through the gastrointestinal tract. The small intestine absorbs too much moisture from the stool, resulting in hardened stools that are difficult and painful to pass. This brings about constipation in patients.

Celiac disease symptoms in children 

Celiac disease symptoms can differ from child to child and also depending on age. Gastrointestinal symptoms are commonly seen in children than in adults.

Nausea and vomiting

Nausea and vomiting are noticed in children after the consumption of meals with gluten content.

Chronic diarrhea 

Gluten will always irritate the intestines in individuals with Celiac disease. This gives rise to diarrhoea and digestive symptoms.

Swollen belly 

Gluten-containing foods stimulate swelling in the small intestine, causing villi damage. Villi assist the body in absorbing nutrients.

Constipation 

Constipation may result from Celiac disease because the small intestine absorbs moisture from the stool. Furthermore, a gluten-free diet may reduce fibre intake and cause constipation.

Gas 

Untreated Celiac disease produces common side effects like excessive gas in children. This results from small intestine irritation.

Pale, foul-smelling stools 

The inability of the body to completely absorb nutrients (malabsorption) causes diarrhoea. Malabsorption can also result in stools with high levels of fat, generally known as steatorrhoea. This can cause them to smell bad and become greasy, pale, foamy and foul-smelling.

Dermatitis Herpetiformis 

Dermatitis Herpetiformis (DH) is a chronic, itchy, blistering skin manifestation of Celiac disease, a gluten-sensitive enteropathy.

The root cause of dermatitis herpetiformis is the sensitivity to gluten. An immune reaction occurs when a person with DH eats foods containing gluten. This results in the formation of IgA antibodies in the skin.

How is Celiac disease diagnosed? 

Celiac disease is diagnosed by,

• Blood tests- for identifying the presence of Celiac disease

• Biopsy - to confirm the diagnosis

It is recommended for an individual taking the tests to consume gluten-containing foods during the test for the results to be accurate. Diagnosing early lowers the chance of developing other autoimmune conditions.

Complete Blood Count (CBC)

Blood tests for Celiac disease are done to assess the presence of specific antibodies in the blood. A complete blood count is required to test the overall health and detect a variety of disorders such as anaemia.

Blood tests that are usually taken for Celiac disease are,

• Tissue transglutaminase antibody (tTG), IgA class
• Immunoglobulin A (IgA)
• tTG, IgG
• Deamidated gliadin peptide (DGP) Antibodies (anti-DGP)
• Anti-endomysial antibodies
• anti-reticulin antibody (ARA)

Liver Function Test (LFT)

Liver function tests are tests to measure the number of various enzymes and proteins produced by the liver.

These tests assess the liver's overall health. Patients with Celiac disease frequently have abnormal liver function tests. All patients who have unexplained increases in liver enzymes should be tested for Celiac disease to confirm the diagnosis.

Cholesterol test 

A cholesterol test is a blood test to determine the level of cholesterol and other fats in the blood.

Untreated Celiac disease is associated with lower total cholesterol levels. Researches are yet to confirm the effect of gluten-free diet treatment on the cholesterol profile of the clinically apparent Celiac disease.

Alkaline phosphatase level test 

Alkaline phosphatase is a routine test carried out for the diseases of the liver, intestines, kidneys or gallbladder.

A high Alkaline Phosphatase (ALP) level may indicate untreated Celiac disease.

Serum albumin test 

The serum albumin test is part of the standard panel of liver tests. The amount of a protein called albumin is measured through this blood test.

A low albumin level, also known as hypoalbuminaemia, is an indicator of Celiac disease.

Who is at risk for Celiac disease? 

Certain risk factors can signify the likelihood of developing Celiac disease. Some of these are listed below.

Lupus 

Celiac disease is often associated with other immune-mediated diseases. According to clinical research, Systemic Lupus Erythematosus (SLE) occurs in 2-3% of people with Celiac disease. Both these autoimmune disorders have common biomarkers.

Rheumatoid arthritis 

The results from article number PMC6484500 of the National Library of Medicine show that positive rheumatoid factor and anti-CCP levels were present in patients with Celiac disease. This signifies the presence of inflammatory arthritis in Celiac patients in the past.

Type 1 diabetes 

Celiac disease and type 1 Diabetes are genetically linked autoimmune diseases where the clinical and pathogenic overlap is common. Having one of the diseases increases the chances of getting the other.

A majority of Celiac Disease cases are diagnosed within 5 years of type 1 Diabetes diagnosis. It is therefore suggested for patients to screen for Celiac Disease every now and then after the confirmation of Diabetes.

Celiac disease is said to affect approximately 6% of people with type 1 Diabetes worldwide.

Thyroid disease 

Grave’s disease and Hashimoto’s thyroiditis are autoimmune thyroid conditions. Research points out that people with these diseases have a higher risk of developing Celiac disease in comparison to the general population. Most autoimmune disorders coexist.

A common genetic predisposition between these diseases raises the risk of developing Celiac disease.

Autoimmune liver disease

Celiac disease is usually correlated with autoimmune liver disorders. These diseases include primary biliary cirrhosis, autoimmune hepatitis and primary sclerosing cholangitis.

Celiac disease has been linked to an increasing number of other liver diseases. It is said that diseases of the liver elevate the probability of CD.

Addison’s disease 

Addison’s disease, an adrenal insufficiency, is produced by an autoimmune reaction.

Several studies have found an increased possibility of Celiac disease in Addison's disease patients.

Sjogren’s syndrome 

Sjogren's syndrome is an autoimmune disorder characterised by dryness of the lachrymal and salivary glands, resulting in dry eyes and mouth.

Celiac disease can affect up to 15% of Sjogren's patients and often manifests as asymptomatic Celiac disease.

Down syndrome 

A recent study reveals that people with Down syndrome are 6 times more likely to develop Celiac disease at some point in their lives.

It is, therefore, necessary for Down syndrome-affected individuals to recognise and treat the symptoms to maintain a good quality of life.

Turner syndrome 

Celiac disease can also occur as a result of Turner syndrome. Studies show that 4-6% of Turner syndrome patients have Celiac disease. Thus, people with Turner syndrome should test for Celiac disease regularly.

Lactose intolerance 

Celiac disease patients have injured small intestine which brings about lactose intolerance making them unable to digest lactose.

Lactose intolerance is a very common digestive condition that affects nearly ¾^th of the world's population. Untreated Celiac disease is associated with lactose intolerance.

Intestinal cancer and Intestinal lymphoma 

The risk of certain cancers is high for individuals with Celiac disease. This may be due to the long-term inflammation caused by gluten.

People with Celiac disease who do not adhere to a gluten-free diet are more likely to develop cancer, including intestinal lymphoma and intestinal cancer.

How is Celiac disease treated? 

Celiac disease is typically treated by excluding gluten-containing foods from the diet. This prevents intestine lining damage and related gastrointestinal symptoms.

Though following a strict diet is hard, a dietitian and a doctor can assist and advise on managing the food intake.

The symptoms improve significantly within a few weeks of starting a gluten-free diet. However, it can take a couple of years for the digestive system to recover completely.

Celiac disease is treated solely with diet and no medicines are available for its cure. Medications can however be provided for relieving the symptoms and healing the intestinal inflammation.  

Self-care at home for Celiac disease 

It is very crucial for Celiac disease patients to practise self-care at home. Switching to a diet without gluten isn’t an easy task. Few self-care ideas for individuals with CD are:

• Maintain a food diary - it is used to note down foods consumed throughout a day. It can help the dietitian keep track of the diet pattern.
• Develop a plan for self-care
• Do pre-preparation for meals
• Consume gut-healthy foods
• Practise mindful eating
• Communicate with close ones on problems
• Be stress-free

Food precautions for people with Celiac disease 

Diet is pivotal in the treatment of Celiac disease. Gluten-free foods are preferred and foods with gluten are avoided.

Gluten-containing cereals include oats, wheat, barley and rye. The best alternative options can be rice, quinoa and millets.

Yet another gluten-free superfood is Amaranth. Being naturally free of gluten and nutrient-rich, Amaranth is safe for patients with Celiac disease.

CELIAC DISEASE FOOD GUIDE

Effects of undiagnosed or untreated Celiac Disease

Untreated Celiac disease can lead to other autoimmune disorders like

• Type 1 Diabetes
• Lactose intolerance
• Arthritis
• Lupus and
• Addison’s disease

It can also cause a variety of other conditions such as

• Dermatitis herpetiformis  
• Anaemia
• Osteoporosis
• Infertility
• Neurological conditions such as epilepsy and migraines
• Short stature
• Heart disease and
• Intestinal cancers.

Living with Celiac disease 

Living with Celiac disease can be tiring, not just for the patient but also for the families.

The requirement to strictly adhere to a gluten-free diet can be stressful for families and individuals, contributing to feelings of isolation and decreased quality of life.

Accepting and supporting the patient is vital for coping with the disease. Regular doctor and dietitian consultations are helpful.

Conclusion

Celiac disease is an immune response to gluten foods. Genetic predisposition is the cause of Celiac disease.

Untreated Celiac disease can lead to complications and other autoimmune diseases. The only way to manage the disease is by following a strict gluten-free diet throughout life.

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