Celiac Disease is one of the most common and most underdiagnosed auto-immune conditions in this country today. It is an inflammatory condition of the small intestine, induced by gluten. The symptoms often resemble those of other conditions, so it is often misdiagnosed. Originally considered a rare disease of childhood, CD is now recognized as a common condition that may be diagnosed at any age. Other terms for celiac disease include gluten sensitive enteropathy and non-tropical sprue.
Dermatitis herpetiformis (DH) is the skin manifestation of the disease. All patients with DH have celiac disease. It is a rash that usually occurs in the same place for each patient. This may be on the hands or fingers, forearms, buttocks or scalp or anywhere on the body. The rash typically consists of intensely itchy, small red dots that may develop into blisters or pimples.
Treatment is first and foremost a 100% gluten-free diet. The diet also will prevent the development of lymphoma, that occurs at an increased rate in patients with celiac disease. Drugs (Dapsone) may help patients recover from a severe episode, but are not a substitute for the diet.
Gluten is the term for the storage proteins (gliadin) of wheat. Most gluten proteins are likely to be toxic in celiac disease. Other proteins found in barley (hordeins) and rye (secalins) are also toxic to patients with celiac disease.
The proteins of oats are not toxic to individuals with celiac disease. There are multiple studies from both Europe and the USA demonstrating the safety of oats for patients with celiac disease and dermatitis herpetiformis. The major concern with oats is that most are contaminated with wheat, barley or rye.
Why celiac disease develops in some individuals in childhood and others as adults is unclear. One is not born with the disease. One is born with a genetic tendency to develop the disease. It is considered that gastrointestinal infections may be a factor that can trigger the development of the disease.
CD is very common. It has been reported from each continent. Reports from all countries in Europe, as well as Asia, Australasia, North and South America, Cuba, North Africa as well as the Middle East attest to its widespread distribution. Overall, it is considered to occur in about 1 per 250 individuals. Most recent figures are 1 per 133 in USA, 1 per 122 in Northern Ireland, 1 per 99 in Finnish school children and 1 per 100 in western England, which indicate it occurs in about 0.5 to 1% of those of European descent.
CD causes malabsorption of nutrients. Diarrhea, the hallmark of intestinal diseases, is the single most common symptom. Patients do not have to have diarrhea to be diagnosed. In fact, less than 50% of adults with celiac disease have diarrhea. By far, the majority of those with CD are asymptomatic and not currently diagnosed. Some people are more at risk if they have another autoimmune disease, such as Type I diabetes or Down's Syndrome, or if a first-degree family member has these diseases.
About 5% of those with typical IBS have celiac disease. Other symptoms include bloating and abdominal distention, indigestion or heartburn, weight loss or abdominal pain, liver disease, metabolic bone disease, anemia, osteoporosis, peripheral neuropathy, ataxia (poor balance) or epilepsy. Apthous ulcers in the mouth is considered to be an autoimmune disorder associated with celiac disease. Dental enamel defects are frequent. There is an increased risk of the development of various malignancies including lymphoma. There is also an increased mortality rate in celiac disease that is about two to four times that of the general population. The increased mortality is mainly due to malignancies. The increased mortality returns to that of the general population after about 5 years on a gluten-free diet. This is the main reason that patients are advised to remain on a strict gluten-free diet.
A biopsy is recommended to establish the diagnosis because blood tests only suggest the presence of the disease. A person who has been following a gluten-free diet prior to the biopsy will get inaccurate results from the biopsy. The disease is life long. Diagnosis requires the patient to adhere to the diet throughout their life. A panel of serologic tests that includes IgA and IgG antigliadin antibodies (AGA), anti-endomysial antibodies (EMA), anti-tissue transglutaminase antibodies (anti-tTG) and total IgA level provides the greatest likelihood of establishing the diagnosis of celiac disease.
If one member of a family is found to have CD, it is highly recommended that all blood relatives be tested periodically because the disease tends to be hereditary. A negative result from the blood test does not rule out CD, especially if gluten-containing foods have been consumed six weeks prior to having the test.
The good news to all of this is that a gluten-free diet can be a very healthy diet for anyone to follow since it is high in the consumption of whole foods, especially fruits and vegetables. Also, most celiacs who consciously adhere to the diet can expect to enjoy a full and healthy life.
