Celiac disease (CD) is a common disorder that is known to affect about 1% 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 cluster of proteins present in wheat, rye and barley and their cross bred grains.
The damage to the intestine can lead to a number 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.
Diagnosis of Celiac disease
In the past, physicians had to rely on clinical symptoms and signs alone to suspect the diagnosis of Celiac disease and select patients who would require further investigations for confirmation.
Now, highly effective blood tests are available to screen for Celiac disease. 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.
The definitive diagnosis of Celiac disease 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.
Symptoms of Celiac disease
Patients with Celiac disease can present with numerous symptoms. The classical (typical) symptoms include chronic diarrhea, abdominal pain, malabsorption and weight loss.
However, many patients now present with non-classical (atypical) symptoms includes 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 happens 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 celiac disease 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.
Treatment of Celiac disease
At present, there is no permanent cure for Celiac disease but it can be effectively treated with a gluten-free diet. The adherence to the gluten-free diet must be strict and lifelong.
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 disease 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.