Celiac disease: diagnosis and treatment



What is celiac disease?


Celiac disease is a digestive disorder caused by an abnormal immune reaction to gluten. Celiac disease is also known as:



  • sprue

  • non-tropical sprue

  • gluten-sensitive enteropathy


Gluten is a protein found in foods made with wheat, barley, rye and triticale. It is also found in oats that has been made in processing plants that handle other grains. Gluten can even be found in some medicines, vitamins and lipsticks. Gluten intolerance, also known as gluten sensitivity, is characterized by the body's inability to digest or break down gluten. Some people with gluten intolerance have a slight sensitivity to gluten, while others have celiac disease, which is an autoimmune disorder.


In celiac disease, the immune response to gluten creates toxins that destroy the villi. The villi are small, finger-shaped protrusions within the small intestine. When the villi are damaged, the body can not absorb nutrients from the food. This can lead to malnutrition and other serious health complications, including permanent intestinal damage.


According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 1 in every 141 Americans has celiac disease. People with celiac disease need to eliminate all forms of gluten from their diet. This includes most bread products, baked goods, beer and foods in which gluten can be used as a stabilizing ingredient.


What are the symptoms of celiac disease?


The symptoms of celiac disease usually affect the intestines and the digestive system, but they can also affect other parts of the body. Children and adults tend to have a different set of symptoms.


Symptoms of celiac disease in children.


Children with celiac disease may feel tired and irritable. They can also be smaller than normal and delay puberty. Other common symptoms include:



  • weightloss

  • barf

  • abdominal distension

  • abdominal pain

  • persistent diarrhea or constipation

  • Pale, greasy and malodorous stools.


Symptoms of celiac disease in adults


Adults with celiac disease may experience digestive symptoms. In most cases, however, the symptoms also affect other areas of the body. These symptoms may include:



  • iron deficiency anemia





  • joint pain and stiffness

  • weak and brittle bones

  • fatigue

  • seizures

  • skin disorders

  • Numbness and tingling in the hands and feet.

  • Discoloration of teeth or loss of enamel.

  • pale sores inside the mouth

  • irregular menstrual periods

  • infertility and miscarriage


Dermatitis herpetiformis (DH) is another common symptom of celiac disease. DH is a rash that itches intensely and consists of bumps and blisters. It can develop in the elbows, buttocks and knees. DH affects approximately 15 to 25 percent of people with celiac disease. Those who experience DH usually do not have digestive symptoms.


It is important to keep in mind that symptoms may vary from person to person depending on several factors, including:



  • the amount of time someone was breastfed when he was a baby

  • the age when someone started eating gluten

  • the amount of gluten someone eats

  • the severity of intestinal damage


Some people with celiac disease have no symptoms. However, they can still develop long-term complications as a result of their illness.


Schedule an appointment with your doctor immediately if you suspect that you or your child has celiac disease. When the diagnosis and treatment are delayed, complications are more likely to occur.


Who is at risk for celiac disease?


Celiac disease runs in families. According to the University of Chicago Medical Center, people have a 1 in 22 chance of developing celiac disease if their parents or siblings have the disease.


People who have other autoimmune diseases and certain genetic disorders are also more likely to have celiac disease. Some conditions associated with celiac disease include:



  • lupus

  • Rheumatoid arthritis

  • Diabetes type 1

  • thyroid disease

  • autoimmune liver disease

  • Addison's disease

  • Sjogren's syndrome

  • Down's Syndrome

  • Turner syndrome

  • lactose intolerance

  • intestinal cancer

  • intestinal lymphoma


How is celiac disease diagnosed?


The diagnosis begins with a physical examination and a medical history.


Doctors will also perform several tests to help confirm a diagnosis. People with celiac disease often have high levels of anti-endomysial (EMA) and anti-tissue transglutaminase (tTGA) antibodies. These can be detected with blood tests. The tests are more reliable when they are done while the gluten is still in the diet.


Common blood tests include:



  • complete blood count (CBC)

  • liver function tests

  • cholesterol test

  • alkaline phosphatase level test

  • serum albumin test


In people with DH, a skin biopsy can also help doctors diagnose celiac disease. During a skin biopsy, the doctor will remove small pieces of tissue from the skin to be examined under a microscope. If the skin biopsy and the results of the blood tests indicate celiac disease, an internal biopsy may not be necessary.


In cases where the results of blood tests or skin biopsy are inconclusive, upper endoscopy may be used to detect celiac disease. During upper endoscopy, a thin tube called an endoscope is inserted through the mouth into the small intestine. A small camera connected to the endoscope allows the doctor to examine the intestines and check for damage to the villi. The doctor can also perform an intestinal biopsy, which involves extracting a tissue sample from the intestines for analysis.


How is celiac disease treated?


The only way to treat celiac disease is to permanently eliminate gluten from your diet. This allows the intestinal villi to heal and begin to absorb nutrients properly. Your doctor will teach you how to avoid gluten while following a nutritious and healthy diet. They will also instruct you on how to read the labels on foods and products so you can identify any ingredient that contains gluten.


Symptoms can improve after a few days of eliminating gluten from the diet. However, you should not stop eating gluten until a diagnosis is made. Eliminating gluten prematurely can interfere with the results of the tests and lead to an inaccurate diagnosis.


Food precautions for people with celiac disease.


Maintaining a gluten-free diet is not easy. Fortunately, many companies are now making gluten-free products, which can be found in several grocery stores and specialty food stores. The labels on these products will say "gluten free".


If you have celiac disease, it is important to know what foods are safe. Here is a series of dietary guidelines that can help you determine what to eat and what to avoid.


Avoid the following ingredients:



  • wheat

  • spelled

  • rye

  • barley

  • triticale

  • bulgur

  • durum

  • flour

  • graham flour

  • semolina


Avoid unless the label says gluten-free:



  • beer

  • bread

  • cakes and pies

  • candy

  • cereals

  • cookies

  • cookies

  • croutons

  • sauces

  • imitation meats or seafood

  • oats

  • pasta

  • Processed lunches, sausages and hot dogs.

  • salad dressings

  • sauces (includes soy sauce)

  • self-contained poultry

  • soups


You can eat these gluten-free grains and starches:



  • buckwheat

  • corn

  • amaranth

  • arrowroot

  • cornmeal

  • Flour made from rice, soy, corn, potatoes or beans

  • pure corn tortillas

  • Quinoa

  • rice

  • tapioca


Healthy gluten-free foods include:



  • fresh meat, fish and poultry that have not been breaded, coated or marinated

  • fruit

  • Most dairy products

  • starchy vegetables such as peas, potatoes, including sweet potatoes and corn

  • rice, beans and lentils

  • vegetables

  • Wine, distilled spirits, ciders and liqueurs.


Your symptoms should improve within days or weeks of making these dietary adjustments. In children, the bowel usually heals in three to six months. Intestinal healing can take several years in adults. Once the bowel is completely healed, the body can absorb the nutrients properly.



Reference: https: //www.healthline.com/health/celiac-disease-sprue#overview1






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