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Celiac Disease

Definition

Celiac disease (CD) is a common disorder that is estimated to affect about one percent of the population. It is a condition in which the absorptive surface of the small intestine is damaged by a substance called gluten. Gluten is a group of proteins present in wheat, rye and barley and their cross bred grains. The damage to the intestine can lead to a variety of symptoms and result in an inability of the body to absorb nutrients such as protein, fat, carbohydrates, vitamins and minerals, which are necessary for good health.

Symptoms

Patients with CD can present with a variety of symptoms. The classical (typical) symptoms include chronic diarrhea, abdominal pain, malabsorption and weight loss. However, many patients now present with non-classical (atypical) symptoms including anemia, osteoporosis, extreme fatigue, oral ulcers, liver enzyme abnormalities, constipation, infertility, dental enamel defects, neurological problems, etc. Children can present with short stature, irritability, vomiting, etc.

Celiac disease occurs commonly in patients with other autoimmune disorders such as thyroid disease and type-I diabetes. It can also run in families, both in first and second degree relatives. Therefore, screening of these high risk individuals should be considered.

Since many patients with CD do not present with classical symptoms, delays in diagnosis can occur.

Dermatitis herpetiformis is “celiac disease” of the skin. The patients present with severely itchy blistering rash. The diagnosis can be confirmed with a skin biopsy. Treatment consists of strict gluten-free diet and, in some cases, medications.

Diagnosis

(1). Screening
In the past, physicians had to rely on clinical symptoms and signs alone to suspect the diagnosis of CD and select patients who would require further investigations for confirmation. Now, highly effective blood tests are available to screen for CD. The IgA-tissue transglutaminase (TTG) antibody is the currently recommended test for screening. The patients must be on a regular (gluten-containing) diet at the time of testing to make the results valid.

(2). Biopsy
The definitive diagnosis of CD is made by a small intestinal biopsy. The biopsy is performed via endoscopy by gastroenterologists. Again, it is important that gluten not be removed from the diet before the biopsy is completed as it may impair the confirmation of the diagnosis.

Treatment

At present, there is no permanent cure for CD but it can be effectively treated with a gluten-free diet. The adherence to the gluten-free diet must be STRICT and LIFE-LONG. Gluten-free diet can be challenging and complicated and a consultation with a registered dietitian with expertise in gluten-free diet is essential.

Individuals with celiac CD need to vigilant about hidden sources of gluten and cross contamination in food products. Careful label reading each time when buying products is important.

Since celiac disease is a chronic disorder, regular long-term follow-up with the physician and dietitian is recommended.

Developed by the CCA Professional Advisory Council
June 2016

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