Celiac disease is a multi-system disorder caused by the body's immune system reacting to the proteins of wheat, rye and barley. The immune reaction damages the lining of the small intestine causing reduced nutrient absorption and a range of symptoms that can include diarrhea, nausea, abdominal pain, weight loss, and fatigue, or even constipation, in some. Some patients are inappropriately labeled as having irritable bowel syndrome or other diseases when the diagnosis of celiac disease is not considered.
Celiac disease affects all age groups from infancy to adulthood. The disease occurs in approximately 1 in 100 people in the United States yet only a small percentage of individuals with celiac disease are diagnosed. Current estimates are that there are more than 2 million people in the United States with celiac disease who have not been diagnosed.
Symptoms
Celiac disease can appear at any time in a person’s life. Symptoms can occur in the digestive system or in other parts of the body. Symptoms also vary a great deal and can make a definitive diagnosis quite difficult. One person may have depression or irritability or mainly fatigue while another may have diarrhea or constipation, gas, bloating or abdominal pain. These symptoms sometimes first appear after an episode of gastroenteritis, severe emotional distress, abdominal surgery, pregnancy or childbirth.
Look for any of the following symptoms:
- Bloating, gas or abdominal pain
- Constipation or diarrhea
- Significant unexplained weight loss
- Chronic fatigue and weakness
- Unexplained anemia
- Recurrent gas, bloating and abdominal pain
- Premature onset of osteoporosis
- Autoimmune thyroid disease
- Autoimmune liver disease
- Very itchy skin rash with small blisters
- Irritability or behavior change
- Mouth ulcers
- Tingling or numbness in hands or feet
- Migraine headaches
Diagnosis
Celiac Disease is an immune-mediated disorder that affects primarily the gastrointestinal tract, however it is now recognized that Celiac Disease affects other organ systems without overt GI symptoms, which adds a diagnostic challenge to healthcare providers caring for patients with Celiac Disease.
Several blood tests are available to test for celiac disease. The major ones are the IgA tissue transglutaminase antibody (also known as the TTG), the IgA anti-endomysial antibody and more recently the IgA antibody to deamidated gliadin. While very useful for screening detection, the blood tests are not perfect and if positive, can be considered very suggestive of celiac disease. They are not meant to replace the small intestinal biopsy which is absolutely required to establish a definite diagnosis of celiac disease. Individuals should not start a gluten-free diet prior to confirming the diagnosis of celiac disease by small intestinal biopsy. This is because the damage to the small intestine that is caused by gluten in patients with celiac disease is reversible and eliminating gluten from the diet before the biopsy is obtained can interfere with obtaining accurate test results. This can make it very difficult to obtain an accurate diagnosis in the absence of restarting a gluten containing diet. Currently, treatment for celiac disease is a lifelong gluten-free diet. As the gluten-free diet can be challenging and lifestyle altering, it is very important to undergo an accurate diagnostic work-up for celiac disease before starting a gluten-free diet.
More information
- To schedule an appointment with Dr. Greg Harmon at the Adult Celiac Center, call (619) 543-2347
- To learn more about treatment options, clinical trials and tips for patients, visit the Wm. K. Warren Celiac Disease Center website.