Celiac Disease - Types, Causes, Symptoms, Risk Factors, Diagnosis, and Treatment

Introduction:

Celiac disease is a digestive system disease, primarily affecting the small intestine. Celiac disease is a long-term autoimmune disorder in which the immune system (the body's defense against infections) mistakenly attacks the healthy tissue. An abnormal immune reaction to gluten causes celiac disease, damaging the villi, tiny finger-like projections found along the small intestine wall. When villi are damaged, the small intestine cannot properly absorb nutrients into the body.

Celiac disease is also known as celiac sprue, non-tropical sprue, and gluten-sensitive enteropathy. Celiac disease is different from gluten intolerance or gluten insensitivity because of its autoimmune nature. Celiac disease affects both children and adults. This disease commonly affects females more than males. Celiac disease affects one in 100 people.

What Are the Types of Celiac Disease?

The World Gastroenterology Organization says that celiac disease is of two types: classical and non-classical.

- The classical celiac disease shows signs and symptoms of malabsorption, including;

1. Diarrhea.

2. Steatorrhea (pale, foul-smelling, fatty stools).

3. Weight loss.

4. Growth failure in children.

- The non-classical celiac disease shows mild gastrointestinal symptoms without clear malabsorption signs or unrelated symptoms.

- Silent celiac disease is otherwise known as asymptomatic celiac disease. Patients do not have any symptoms, but the villi are damaged.

What Are the Causes of Celiac Disease?

Celiac disease is a multifactorial disease including environmental and genetic factors.

Celiac disease is caused by an immune reaction to gluten and oats. Many other products containing gluten can cause this disease. Celiac disease is hereditary. Around 90% of the population showed the HLA-DQ2 gene, whereas the remaining showed the HLA-DQ8 gene. HLA-DQ2 genes increase the risk of abnormal immune response to gluten. Irregular breastfeeding patterns in the first year of birth and viral infections such as rotavirus can also cause celiac disease.

What Are the Signs and Symptoms?

Celiac disease symptoms can range from mild to severe and vary from person to person. Celiac disease can also be asymptomatic in some cases.

Symptoms in adults include:

• Nausea, vomiting, and diarrhea.

• Constipation.

• Fatigue and weight loss.

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• Abdominal pain, bloating, and gas.

• Pale foul-smelling fatty stool.

• Iron deficiency anemia.

• Osteoporosis (weak bones that break easily).

• Stiff and painful joints.

• Mouth ulcers.

• Itchy blistering skin rash (dermatitis herpetiformis).

• Depression and anxiety.

• Seizures and headaches.

• Missed menstrual periods.

• Infertility and miscarriage.

Symptoms in children include:

• Vomiting and diarrhea.

• Abdominal pain, bloating, and gas.

• Irritability and behavioral issues.

• Pale, foul-smelling fatty stool.

• Iron deficiency anemia.

• Short stature.

• Fatigue and weight loss.

• Delayed growth and puberty.

• Dental enamel defects of permanent teeth.

What Are the Risk Factors of Celiac Disease?

Celiac disease can develop in the presence of other autoimmune diseases. The risk factors include:

• A close family member with celiac disease or dermatitis herpetiformis.

• Type 1 Diabetes - The condition in which the pancreas produces little or no insulin.

• Down’s Syndrome - It is a genetic disorder in which the person has an extra chromosome (chromosome 21).

• Turner Syndrome - It is a condition in which the female has a missing or incomplete sex chromosome.

• Autoimmune Thyroid Disease - It is a condition in which the immune system attacks the thyroid gland in the neck.

• Lupus - An inflammatory disease in which the immune system attacks its own tissues such as joints, skin, blood cells, brain, heart, and lungs.

• Sjogren's Syndrome - An immune system disorder characterized by dry eyes and dry mouth.

• Irritable Bowel Syndrome - A disorder which affects the large intestine.

How Can We Diagnose Celiac Disease?

• Physical examination and thorough medical history can rule out celiac disease.

• Serology testing finds out antibodies in your blood. High levels of specific antibody proteins indicate an immune reaction to gluten.

• Patients should be eating gluten before the blood test. Cutting out gluten during testing may mislead the diagnosis.

• Genetic testing of human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to diagnose celiac disease.

• Complete blood count to diagnose anemia and look for vitamin and mineral deficiencies.

• Bone density test to check for bone loss.

• Endoscopy is done if the blood and other tests do not rule out celiac disease. Endoscopy is done by inserting a small flexible tube containing a tiny camera into the mouth to view the small intestine and a small piece of tissue (biopsy) is removed from the small intestine wall. This biopsy tissue is examined under a microscope to see whether the villi are damaged.

How Is Celiac Disease Treated?

A strict lifelong gluten-free diet is the only way to treat celiac disease.

Vitamin supplements are given for vitamin B12, vitamin K, and iron deficiencies. This allows the intestine to heal and to begin absorbing nutrients properly. For children, the gluten-free diet will allow the small intestine to recover in three to six months. Complete healing might take several years in adults. Medical follow-ups at regular intervals ensure that symptoms have improved due to a gluten-free diet.

What to Eat and Avoid?

Foods to eat (that do not contain gluten) include:

• Fresh meat and poultry.

• Eggs.

• Nuts.

• Herbs and spices.

• Fish and seafood.

• Diary.

• Fruits and vegetables.

• Cereals such as corn and millet.

• Rice flour.

• Tapioca.

Gluten is present naturally in wheat, barley, and rye. These foods and those listed below should be avoided.

Many processed foods containing gluten include:

• Soy sauce.

• Canned soups.

• Salad dressings.

• Ketchup and seasonings.

• Ice cream.

• Candy bars.

• Chewing gum.

Non-food products also contain gluten, including:

• Some prescription and over-the-counter medications.

• Toothpaste.

• Cosmetics include lipstick, lip balm, and lip gloss.

• Vitamin and mineral supplements.

• Herbal and nutritional supplements.

Patients with celiac disease should always look for the labels of food or other products to ensure the presence of gluten.

What Is Refractory Celiac Disease?

Some people develop refractory celiac disease in which the body does not respond to a gluten-free diet for 12 months. Refractory celiac disease is rare, affecting one to two percent of people with celiac disease. People over 50 years are mostly affected. Steroid medication such as Prednisone is used to treat this disease.

What Are the Complications?

People with celiac disease are at greater risk of developing coronary artery disease and small bowel cancers. Repetitive exposure to gluten damages the intestinal lining and can lead to nutritional deficiency resulting in iron deficiency anemia, hair loss, weakening bones (osteoporosis), vitamin B12 and folate deficiency anemia, and malnutrition.

Conclusion:

Celiac disease is lifelong, but symptoms can be relieved with a gluten-free diet. With correct diagnosis and regular follow-ups, the celiac disease shows good improvement and excellent prognosis.