Celiac Disease Health Article

Definition

Celiac disease occurs when the body reacts abnormally to gluten, a protein found in wheat, rye, barley, and oats. Gluten causes an inflammatory response in the small intestine, which damages the tissues and results in impaired ability to absorb nutrients from foods.

Description

Celiac disease—also called sprue, nontropical sprue, gluten sensitive enteropathy, celiac sprue, and adult celiac disease—may be discovered at any age. Researchers believe that a combination of genetic and environmental factors trigger the disease. Environmental events that may provoke celiac disease in those with a genetic predisposition to the disorder include surgery or a viral infection.

The disorder is more commonly found among white Europeans or those of European descent. The exact incidence of the disease is uncertain. Estimates vary from one in 5,000 to as many as one in every 300 individuals with this background. In 2002, new research in Italy followed patients with type 1 diabetes. Celiac disease is 20 times more common among these patients than in the general population, yet often goes undetected in these children. The study authors recommended celiac disease screening programs for children recently diagnosed with type 1 diabetes.

Causes & symptoms

Celiac disease is caused by an inflammatory response of the small intestine. The exact mechanism of the disorder is not clearly understood, but it is known that both heredity and the immune system play a part. When food containing gluten reaches the small intestine, the immune system begins to attack a substance called gliadin, which is found in the gluten. The resulting inflammation causes damage to the delicate finger-like structures in the intestine, called villi, where food absorption actually takes place.

The most commonly recognized symptoms of celiac disease relate to the improper absorption of food in the gastrointestinal system. The patient will have diarrhea and fatty, greasy, unusually foul-smelling stools. The patient may complain of excessive gas (flatulence), distended abdomen, weight loss, and generalized weakness.

Not all patients have these problems. Unrecognized celiac disease may cause or contribute to a variety of other conditions. The decreased ability to digest, absorb, and utilize food properly (malabsorption) may cause anemia from iron deficiency or easy bruising from a lack of vitamin K. Poor mineral absorption may result in osteoporosis, which may lead to bone fractures. Vitamin D levels may be insufficient and bring about a "softening" of bones (osteomalacia), which produces pain and bony deformities. Defects in the tooth enamel, characteristic of celiac disease, may also occur. Celiac disease may be discovered during medical tests performed to investigate failure to thrive in infants, or lack of proper growth in children and adolescents. People with celiac disease may also experience lactose intolerance because they do not produce enough of the enzyme lactase, which breaks down the sugar in milk into a form the body can absorb.

A distinctive skin rash, called dermatitis herpetiformis, may be the first sign of celiac disease. Approximately 10% of patients with celiac disease have this rash, but it is estimated that 85% or more of patients with the rash have the disease.

Because of the variety of ways celiac disease can manifest itself, it is often not discovered promptly. The condition may persist without diagnosis for so long that the patient accepts a general feeling of illness as normal. This leads to further delay in identifying and treating the disorder.