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Celiac Disease: Causes, Symptoms and Treatments

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March 3, 2016 | Published by


What is Celiac Disease?

diagram of digestive systemCeliac disease is an immune disorder in which people cannot tolerate gluten because it damages the inner lining of their small intestine and prevents it from absorbing nutrients. The small intestine is the tubeshaped organ between the stomach and large intestine. Gluten is a protein found in wheat, rye, and barley and occasionally in some products such as vitamin and nutrient supplements, lip balms, and certain medications.

The immune system is the body’s natural defense system and normally protects the body from infection. However, when a person has celiac disease, gluten causes the immune system to react in a way that can cause intestinal inflammation—irritation or swelling—and long-lasting damage.

When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike projections on the inner lining of the small intestine. Villi normally absorb nutrients from food and pass the nutrients through the walls of the small intestine and into the bloodstream. Without healthy villi, people can become malnourished, no matter how much food they eat.

What Causes Celiac Disease?

Researchers do not know the exact cause of celiac disease. Celiac disease sometimes runs in families. In 50 percent of people who have celiac disease, a family member, when screened, also has the disease.1

A person’s chances of developing celiac disease increase when his or her genes—traits passed from parent to child—have variants, or changes. In celiac disease, certain gene variants and other factors, such as a person’s exposure to things in his or her environment, can lead to celiac disease.

For most people, eating something with gluten is harmless. For others, an exposure to gluten can cause, or trigger, celiac disease to become active. Sometimes surgery, pregnancy, childbirth, a viral infection, or severe emotional stress can also trigger celiac disease symptoms.

What Are the Signs and Symptoms of Celiac Disease?

A person may experience digestive signs and symptoms, or symptoms in other parts of the body. Digestive signs and symptoms are more common in children and can include

  • abdominal bloating
  • chronic diarrhea
  • constipation
  • gas
  • pale, foul-smelling, or fatty stool
  • stomach pain
  • nausea
  • vomiting

Being unable to absorb nutrients during the years when nutrition is critical to a child’s normal growth and development can lead to other health problems, such as

  • failure to thrive in infants
  • slowed growth and short stature
  • weight loss
  • irritability or change in mood
  • delayed puberty
  • dental enamel defects of permanent teeth

Adults are less likely to have digestive signs and symptoms and may instead have one or more of the following:

  • anemia
  • bone or joint pain
  • canker sores inside the mouth
  • depression or anxiety
  • dermatitis herpetiformis, an itchy, blistering skin rash
  • fatigue, or feeling tired
  • infertility or recurrent miscarriage
  • missed menstrual periods
  • seizures
  • tingling numbness in the hands and feet
  • weak and brittle bones, or osteoporosis
  • headaches

Intestinal inflammation can cause other symptoms, such as

  • feeling tired for long periods of time
  • abdominal pain and bloating
  • ulcers
  • blockages in the intestine

Celiac disease can produce an autoimmune reaction, or a self-directed immune reaction, in which a person’s immune system attacks healthy cells in the body. This reaction can spread outside of the gastrointestinal tract to affect other areas of the body, including the

  • spleen
  • skin
  • nervous system
  • bones
  • joints

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. Celiac disease can be confused with

  • irritable bowel syndrome (IBS)
  • iron-deficiency anemia caused by menstrual blood loss
  • lactose intolerance
  • inflammatory bowel disease
  • diverticulitis
  • intestinal infections
  • chronic fatigue syndrome

As a result, celiac disease has long been underdiagnosed or misdiagnosed. As health care providers become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing, particularly for adults.

How is Celiac Disease Treated?

gluten free aisle by Flickr user Memphis CVBMost people with celiac disease have a significant improvement in symptoms when they follow a gluten-free diet. Health care providers typically refer people to a dietitian who specializes in treating people with the disease. The dietitian will teach the person to avoid gluten while following a healthy and nutritious diet. The dietitian will give the person instructions for how to

  • read food and product labels and identify ingredients that contain gluten
  • make healthy choices about the types of foods to eat
  • design everyday meal plans

For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Symptoms may improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi will absorb nutrients from food into the bloodstream normally.

Some people with celiac disease show no improvement after starting a gluten-free diet. The most common reason for poor response to dietary changes is that people are still consuming small amounts of gluten, which can damage the small intestine—even in people without symptoms. Most people start responding to the gluten-free diet once they find and eliminate hidden sources of gluten from their diet. Hidden sources of gluten include additives made with wheat, such as

  • modified food starch
  • preservatives
  • stabilizers

Did You Know That Medications and Nonfood Products May Contain Gluten?

assortment of pillsMedications, supplements, and other products may also contain lecithin, a hidden source of gluten. People with celiac disease should ask a pharmacist about the ingredients in

  • prescription and over-the-counter medications
  • vitamins and mineral supplements
  • herbal and nutritional supplements

Other products can be ingested or transferred from a person’s hands to his or her mouth. Reading product labels can help people avoid gluten exposure. If a product’s label does not list its ingredients, the manufacturer should provide a list upon request.

Products that can contain gluten include

  • lipstick, lip gloss, and lip balm
  • cosmetics
  • skin and hair products
  • toothpaste and mouthwash
  • glue on stamps and envelopes
  • children’s modeling dough, such as Play-Doh

Some people who continue to have symptoms even after changing their diet may have other conditions or disorders that are more common in people with celiac disease. These conditions may include

  • small intestinal bacterial overgrowth, which happens when too many bacteria grow in the small intestine
  • pancreatic exocrine insufficiency, in which the pancreas does not produce enough digestive juice
  • microscopic colitis, an inflammation of the colon that a health care provider can see only with a microscope
  • IBS
  • lactose intolerance, a condition in which people have symptoms after consuming milk or milk products
  • other food intolerances, which may occur because of continued damage to the intestine

In some cases, people continue to have difficulty absorbing nutrients despite following a strict gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Their intestines are not absorbing enough nutrients, so they may need to receive nutrients intravenously. Researchers continue to evaluate medications to treat refractory celiac disease.

Depending on a person’s age at diagnosis, some complications of celiac disease will not improve, such as short stature and dental enamel defects.

For people with dermatitis herpetiformis, skin symptoms generally respond to a gluten-free diet and may recur if a person adds gluten back into his or her diet. Medications such as dapsone can control the rash’s symptoms. Dapsone does not treat intestinal symptoms or damage, so people with dermatitis herpetiformis should maintain a gluten-free diet, even if they don’t have digestive symptoms. Even when a person follows a gluten-free diet, the skin lesions from dermatitis herpetiformis may take months or even years to fully heal and often recur over the years.

Eating, Diet, and Nutrition

elbow macaroni noodlesEating, diet, and nutrition play a significant role in treating celiac disease. People with the disease should maintain a gluten-free diet by avoiding products that contain gluten. In other words, a person with celiac disease should not eat most grains, pasta, and cereal, and many processed foods.

People with celiac disease can eat a wellbalanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores, or order products from special food companies. Meanwhile, “plain”—meaning no additives or seasonings—meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat these foods.

In the past, health care providers and dietitians advised people with celiac disease to avoid eating oats. Evidence suggests that most people with the disease can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should talk with their health care team when deciding whether to include oats in their diet.

Eating out and shopping can be a challenge. Newly diagnosed people and their families may find support groups helpful as they adjust to a new approach to eating. People with celiac disease should

  • read food labels—especially canned, frozen, and processed foods—for ingredients that contain gluten
  • avoid ingredients such as hydrolyzed vegetable protein, also called lecithin or soy lecithin
  • ask restaurant servers and chefs about ingredients and food preparation inquire whether a gluten-free menu is available
  • ask a dinner or party host about glutenfree options before attending a social gathering

Foods that are packaged as gluten-free tend to cost more than the same foods containing gluten. People following a gluten-free diet may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.

Content for this blog courtesy of National Institute of Diabetes and Digestive and Kidney Diseases

Image Credits: Gluten-free aisle by Flickr user Memphis CVB

References

  1. Rubio-Tapia A, Van Dyke CT, Lahr BD, et al. Predictors of family risk for celiac disease: a population-based study. Clinical Gastroenterology and Hepatology. 2008;6(9):983–987.
  2. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. American Journal of Gastroenterology. 2012;107(10):1538–1544.
  3. Ruiz AR. Celiac disease. The Merck Manual website. www.merckmanuals.com/professional/gastrointestinal_disorders/malabsorption_syndromes/celiac_disease.html. Updated May 2014. Accessed August 27, 2014.
  4. Ahn R, Ding YC, Murray J, et al. Association analysis of the extended MHC region in celiac disease implicates multiple independent susceptible loci. PLoS ONE. 2012;7(5):e36926.
  5. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG Clinical Guidelines: diagnosis and management of celiac disease.American Journal of Gastroenterology. 2013;108(5):656–676.

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