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What is Celiac disease? Causes Symptoms and Treatment

What is Celiac disease

Celiac Disease Causes Symptoms and Treatment

 

What is Celiac disease?

Celiac disease, also spelled coeliac disease (CD) is a lifelong autoimmune disease which affects 1 in 100 people, it is triggered by a reaction to glutenin and gliadin, two gluten proteins mainly found in food that contain wheat, barley and rye. Common symptoms include abdominal bloating, diarrhea and flatulence (excessive wind). Coeliac disease occurs especially in people who are genetically susceptible. An exact diagnosis of coeliac disease can only be made by endoscopic small intestinal biopsy.

Who gets celiac?

Celiac disease affects people of all backgrounds, regardless of sex, age, ethnicity or race, although Caucasians report the condition more often than Latinos and African Americans. 10-20% of people with coeliac disease have a first degree relative who also has celiac disease. Celiac disease affects about 3 million Americans

Who Gets Celiac

Is celiac disease a serious condition?

Celiac disease primarily affects the proximal two-thirds of the small intestine (small bowel mucosa). In most cases, Coeliac disease affects the duodenal mucosa (the innermost layer of the duodenum) whereas the submucosa, muscularis and serosa remain unaffected. The presence of inflammation and villous atrophy in the small intestine is characteristic. Without early diagnosis and prompt treatment, celiac disease can result in serious complications.

Symptoms

What are the symptoms of celiac disease?

The symptoms of coeliac disease can vary greatly from individual to individual. Some people experience severe symptoms, while others may only have mild nonspecific symptoms such as chronic fatigue, inability to gain weight, and iron deficiency anemia. Nearly half of people with coeliac disease are asymptomatic.

The signs and symptoms of celiac disease can be mild or severe and may include:

  1. Cramping, abdominal pain, constipation or diarrhea, with or without abdominal bloating, pressure and gas. Symptoms of IBS
  2. Flatulence (excessive wind)
  3. Pale foul-smelling or fatty stool (steatorrhea)
  4. Persistent nausea and vomiting
  5. Epigastric pain, stomach cramps, heartburn, palpitations and right upper quadrant pressure and fullness. Symptoms of acid reflux disease
  6. Chronic fatigue syndrome
  7. Nausea and vomiting
  8. Chronic muscle pain, muscle weakness, lack of physical or muscle strength, sleep problems, and pain in multiple tender points that usually occurs on both sides of the body (symmetrical). Fibromyalgia syndrome
  9. Iron, vitamin B12 or folic acid deficiency
  10. Headaches
  11. Weight loss
  12. Hair loss (alopecia)
  13. Dermatitis herpetiformis or skin rash
  14. Dental enamel defects
  15. Osteoporosis
  16. Depression
  17. Infertility
  18. Joint pain (arthralgia) and/or bone pain (osteodynia or ostealgia)
  19. Neurological symptoms such as ataxia or poor muscle coordination
  20. Symptoms of neuropathy, this includes numbness and tingling in the hands and feet
  21. Irritability and aggressive behavior
  22. Short stature and delay of growth and puberty
  23. Failure to thrive (FTT) syndrome
  24. Attention deficit hyperactivity disorder (ADHD)

bone with osteoporosis

What are the warning signs of celiac disease in infants and younger children?

Symptoms of celiac disease in infants and younger children

If you have an infant with celiac disease, he is likely to have digestive problems. Common symptoms of celiac disease in infants and children include:

  1. Abdominal bloating and pain
  2. Chronic fatigue
  3. Delay of growth and puberty
  4. Weight loss
  5. Rectal Bleeding and changes in normal bowel habits (diarrhea or constipation)
  6. Flatulence (excessive wind)
  7. Nausea and vomiting
  8. Irritability and aggressive behavior
  9. Failure to thrive syndrome

Your child may also show symptoms of malnutrition. His stomach may bloat, while the arms and legs look thin

bloated stomach malnutrition

What are the warning signs of celiac disease in children or teens?

Symptoms of celiac disease in children and teens

In most cases, teens with celiac disease remain asymptomatic until they’re stressed about something. Symptoms usually appear when they start work, leave home or after an injury, illness, or pregnancy. Typical early signs or symptoms of celiac disease in children and teens include diarrhea, weight loss, fatigue, flatulence (excessive wind), abdominal pain and bloating

Other symptoms of celiac disease in teens or children include:

  1. Delayed puberty
  2. Short stature and growth problems
  3. Depression
  4. An itchy, blistering skin rash (dermatitis herpetiformis)
  5. Canker sores or aphthous ulcers

When to Call Your Doctor

See your doctor if you suspect your child has celiac disease. for those who have it, a gluten free diet can help prevent common celiac disease complications like malnutrition, infertility, osteoporosis and neurological problems.

In 20% of all cases, celiac disease runs in families, so if you have a first degree relative who has it, you may want to get checked.

The symptoms of celiac disease can mimic IBS symptoms, so if you have been diagnosed with IBS without being tested for coeliac disease and you’re still having celiac disease symptoms, you should be tested for celiac disease.

What are the symptoms of celiac disease in adults?

Adults are less likely to have digestive symptoms. Only 35% of newly diagnosed adults had chronic diarrhea.

In adults, common symptoms include:

  1. Iron deficiency anemia
  2. Chronic fatigue and brain fog
  3. Seizures or migraines
  4. Depression or anxiety
  5. Keratosis Pilaris (dry rough patches and tiny bumps on your upper arms or thighs)
  6. Arthritis
  7. Arthralgia (joint pain) or osteodynia (bone pain)
  8. Osteoporosis (weak and brittle bones) or osteopenia (reduced bone density)
  9. Liver and biliary tract disorders (fatty liver, transaminitis, primary sclerosing cholangitis, etc.)
  10. Canker sores (mouth sores)
  11. Dermatitis herpetiformis (itchy skin rash), which is triggered by ingesting gluten
  12. Peripheral neuropathy (numbness, pain or tingling in the hands and feet)
  13. Missed or irregular periods
  14. Infertility and recurrent pregnancy loss

dermatitis herpetiformis

Coeliac disease symptoms after eating gluten?

Celiac disease is provoked by contact with three main types of gliadin (α, γ, and ω). The symptoms a person with celiac disease may experience after eating gluten containing products can vary. However, in most cases, symptoms occur shortly after eating gluten and improve or disappear within hours after gluten is withdrawn. Symptoms of celiac disease return again immediately after consuming gluten. Symptoms of gluten sensitivity include severe diarrhea and/or constipation, bloating and gas (abdominal distention), cramping, nausea, vomiting, stomach cramps, right upper quadrant discomfort, recurrent stomach pain, fatigue, palpitations (a fast heartbeat), hypotension, dizziness or feeling faint when standing up, excessive sweating, bladder symptoms. If you don’t follow a gluten free diet and if you eat gluten with celiac disease, it can lead to any combination of iron, vitamin B12 or folic acid deficiency, hair loss, skin changes, sexual dysfunction, and can result in severe life-threatening complications.

Causes

What are the causes of celiac disease?

Celiac disease is a lifelong autoimmune condition that occurs after initial immune activation. Celiac disease (CD) patients develop innate and adaptive immune response to wheat gliadin.

There is very little data on how celiac disease is triggered for the first time but over time researchers have identified some risks. Researchers believe that an environmental trigger is needed for celiac disease to occur. Celiac disease triggers include severe emotional stress, heredity, H pylori infection, HIV, hepatitis, gastroenteritis due to reovirus, diabetes, thyroid disease, pregnancy, childbirth, cardiomyopathy, surgery, and other viral infections. When the body’s immune system overreacts to gluten, it makes antibodies to the gluten. These autoantibodies can cause damage or other problems to the tiny, finger-like projections (villi) that line the small intestine

normal and deformed intestinal villi

What is the main cause of celiac disease?

Although a clear cause has not been established yet on how celiac disease is triggered for the first time. Several environmental factors or triggers are believed to play an important role in its activation. Once an adaptive immune response is activated by exposure to gluten, your immune system treats gliadin as a threat to the body and attacks it by forming antibodies to gluten, resulting in CD4+ T cell-mediated immunity against gluten.

In the case of celiac disease, your immune system treats gliadin, as a threat to the body. Your body makes antibodies to the gluten. This results in the formation of IgA antibodies against deamidated gliadin peptides (TTG), antigliadin antibodies (AGA), endomysial antibodies (EmA), and anti-tissue transglutaminase antibodies (anti-tTG or anti-TG2). These autoantibodies cause intestinal inflammation and swelling and, if left undetected, can eventually lead to villous atrophy

Is celiac disease hereditary?

Celiac disease runs in families. People with a first-degree relative with celiac disease have a 90% chance of not developing celiac disease.

If you have a first-degree relative with celiac disease (a sibling or parent), there’s about a 10% chance you’ll develop it

People with coeliac disease have one of either HLA DQ2.5, HLA DQ8, or HLA DQ2.2 genes associated with celiac disease risk. These genes are responsible for anti-gluten T cell response

What are the risk factors for celiac disease?

Risk factors for celiac disease include:

  1. A first-degree relative with celiac disease
  2. HLA DQ2.5, HLA DQ8, or HLA DQ2.2 genes
  3. Some autoimmune disease (chronic Autoimmune thyroiditis, type 1 diabetes, primary biliary cirrhosis, sjogren’s syndrome, etc.)
  4. Selective IgA Deficiency (SIgAD)
  5. Down syndrome

Diagnosis

How is celiac disease diagnosed in adults?

Can you test for celiac disease with a blood test?

If you suspect celiac disease, or if you are continuing to experience celiac disease symptoms after a negative tTG-IgA test, talk to your physician about performing further tests. In order for the endoscopy and celiac disease blood tests to be accurate, the patient must be on a gluten containing diet.

Blood screening tests. There are several serologic blood tests available that indicate the possibility of celiac disease, to help identify people who may have coeliac disease. If the blood tests and symptoms indicate celiac disease your physician will likely suggest an endoscopic small intestinal biopsy to confirm the diagnosis.

Endoscopic small intestinal biopsies can be used to confirm the diagnosis of coeliac disease after a positive tTG-IgA test

To help diagnose celiac disease, doctors request a serologic blood test that provides an effective first step in identifying people with suspected coeliac disease. The IgA-tTG test is the most common screening test for coeliac disease.

Patients with positive serologic test results should be referred to a gastroenterologist for endoscopic small intestinal biopsies to confirm the diagnosis.

How to diagnose celiac disease and what is a tTG blood test for?

A tissue transglutaminase (tTG) IgA and/or IgG test is a screening blood test used to help identify people who may have celiac disease, especially when an individual is in a risk group for celiac disease. This test is used to screen for celiac disease antibodies.

For the tTG and EMA blood tests to be accurate, one must be eating gluten every day.

If tTG-IgA is normal then the IgA-DGP blood test should be used to take a decision regarding the need for an endoscopy to confirm the diagnosis. However, if tTG-IgA is weakly positive then the antiendomysial antibody test (EMA) can be used to confirm the positive tTG-IgA test. If the tTG-IgA blood test is positive, your physician will likely suggest a biopsy of your small intestine to confirm the diagnosis.

The IgG tTG blood test may be ordered as an alternative in those who have IgA deficiency. This test have a diagnostic sensitivity, specificity, and positive predictive value of 90%

What is a IgA deficiency?

Selective IgA Deficiency is a frequent form of primary immunodeficiency disease (PIDD) in which the immune system is defective and the ability to fight infections and cancer is compromised. In this case, immunodeficiency is acquired (“primary”) due to defects within the patient’s immune system. People with this disorder have absent serum levels of IgA immunoglobulins. IgA protects against mucosal infections.

Genetic tests to confirm the presence or absence of HLA class II genes that are responsible for celiac disease (CD) predisposition. Testing for HLA-DQ2 (inherited either in an autosomal dominant or autosomal recessive manner) and HLA-DQ8 (inherited in an autosomal dominant manner) can help exclude the diagnosis.

How accurate is the test for celiac disease?

The tissue transglutaminase IgA test (tTG blood test) will show positive results in about 98% of people with celiac disease who eat gluten

What is the blood test for celiac disease?

The anti-tTG IgA and/or IgG test is a blood test used to screen for celiac disease antibodies. If this test is positive, then it can also be used to monitor patients in whom celiac disease was diagnosed and to help evaluate the effectiveness of treatment. Tissue transglutaminase (tTG) autoantibodies decline when gluten is removed from the diet.

Treatment

How to treat celiac disease?

The only way to manage the symptoms of celiac disease is to follow a strict gluten free diet, this involves a lifelong commitment to a gluten free diet and limiting gliadin to less than 20 mg per kg of a food product. This means that you need to avoid cereals (rye, barley, wheat and spelt), foods containing gluten, and alcoholic beverages, like beers (including stouts, ales or lagers), malt beverages, all wheat based vodkas and alegars (malt vinegars) that are made from gluten containing grains.

gluten free diet

Can you be cured of celiac disease?

The gluten free diet (a super restrictive elimination diet) is currently the only way for individuals with gluten sensitivity to get rid of symptoms. For most people, following a gluten free diet is the only way to stop symptoms, heal existing intestinal damage, and prevent further problems and inflammation

Eating any gluten, no matter how small an amount, will trigger debilitating gastrointestinal symptoms, such as diarrhea, stomachache, abdominal pain and cramping, bloating and swelling of your stomach, flatulence (excessive wind)

Can a celiac eat butter?

If you have celiac disease, you can eat gluten free foods, this includes fruits, vegetables, and most dairy products, such as milk, butter and cheese.

Can a celiac eat porridge?

People with celiac disease can safely eat oats; however, problems can occur due to gluten-cross contamination in food services. Oats are naturally gluten-free. However, oats usually become contaminated with gluten during harvesting (harvesting equipment, mechanical sorting machines) and transportation (transporting vehicles, storage units, packaging and production facilities).

People with coeliac disease can safely eat avenin, a protein similar to gluten found in oats.

How to treat gluten intolerance at home?

1. Read food labels when you shop, learning how to read and understand food labels can help you eliminate gluten from diet effectively

2. Use gluten-free starches, like cornstarch, arrowroot starch, tapioca starch/flour, and potato starch, in place of gluten-containing foods

3. Eat foods that are naturally gluten-free

Fruits and vegetables, fish, meat, cheese, poultry and eggs are naturally gluten-free, so use these as the basis of your diet.

4. Enjoy gluten-free grains and cereals.

Use gluten-free grains and cereals, like buckwheat, corn, quinoa, amaranth, polenta, millet, teff and tapioca in place of gluten-containing grains and cereals

5. Know which alcohol to avoid

Gluten free alcohol includes cider, wine, rum, tequila, spirits, sherry, port, liqueurs, and potato, corn, or grape based vodka. Moreover, gluten free beers are also available, but make sure you only drink those that are labelled gluten free.

6. Be aware of cross contamination

Even a tiny bit of gluten can be enough to trigger debilitating gastrointestinal symptoms. Minimize the risk of cross contamination with gluten containing foods. This can be done by washing down kitchen surfaces before use, using toaster bags to keep your gluten free bread separate, and using separate butters, jams and spreads.

7. Avoid sauces containing gluten

Lots of pasta gravies, sauces, condiments and stocks contain wheat gluten, so ensure you read the label and make sure you only buy and use those that are labelled gluten free. Instead, Try making your own sauces using arrowroot, cornflour or potato starch to thicken them for a gluten free option.

8. Enjoy meals out with family and friends

Eating out with family and friends is a way to relieve stress and minimize symptoms. Reducing stress allows the villous atrophy in the small intestines to heal once again and thus it helps prevent future complications

 

 

 

 

 

References

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