Vidyya Medical News Servicesm
Vidyya, from the Sanskrit "vaidya," a practitioner who has come to understand the science of life.

Volume 1 Published - 14:00 UTC    08:00 EST    20-APR-2000      
Issue 7 Next Update - 14:00 UTC 08:00 EST    21-APR-2000      

Vidyya Home  Vidyya

Home Of Our Sponsor, Vidyya.  Vidyya. Home

Vidyya Archives  Vidyya Archives

Search Vidyya  Search Vidyya

Visit Our Library  Ex Libris

Subscribe To Our News Service  Subscriptions

All About Us  About Vidyya



















Back To Vidyya Disease Of The Week

Celiac Disease


What Is Celiac Disease?

Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye, barley, and possibly oats. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny fingerlike protrusions, called villi, on the lining of the small intestine are lost. Nutrients from food are absorbed into the bloodstream through these villi. Without villi, a person becomes malnourished--regardless of the quantity of food eaten.

Because the body's own immune system causes the damage, celiac disease is considered an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.

Celiac disease is a genetic disease, meaning that it runs in families. Sometimes the disease is triggered--or becomes active for the first time--after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.


What Are the Symptoms?

Villi
Villi on the lining of the small intestine help
absorb nutrients.
Celiac disease affects people differently. Some people develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed--the longer one was breastfed, the later symptoms of celiac disease appear, and the more atypical the symptoms. Other factors include the age at which one began eating foods containing gluten and how much gluten is eaten.

Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression. In fact, irritability is one of the most common symptoms in children.

Symptoms of celiac disease may include one or more of the following:

  • Recurring abdominal bloating and pain.
  • Chronic diarrhea.
  • Weight loss.
  • Pale, foul-smelling stool.
  • Unexplained anemia (low count of red blood cells).
  • Gas.
  • Bone pain.
  • Behavior changes.
  • Muscle cramps.
  • Fatigue.
  • Delayed growth.
  • Failure to thrive in infants.
  • Pain in the joints.
  • Seizures.
  • Tingling numbness in the legs (from nerve damage).
  • Pale sores inside the mouth, called aphthus ulcers.
  • Painful skin rash, called dermatitis herpetiformis.
  • Tooth discoloration or loss of enamel.
  • Missed menstrual periods (often because of excessive weight loss).

Anemia, delayed growth, and weight loss are signs of malnutrition--not getting enough nutrients. Malnutrition is a serious problem for anyone, but particularly for children because they need adequate nutrition to develop properly.

Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease. See Complications.


How Is Celiac Disease Diagnosed?

Diagnosing celiac disease can be difficult because some of its symptoms are similar to those of other diseases, including irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticulosis, intestinal infections, chronic fatigue syndrome, and depression.

Recently, researchers discovered that people with celiac disease have higher than normal levels of certain antibodies in their blood. Antibodies are produced by the immune system in response to substances that the body perceives to be threatening. To diagnose celiac disease, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium, and antireticulin.

If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. This is done in a procedure called a biopsy: the physician eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine, and then takes a sample of tissue using instruments passed through the endoscope. Biopsy of the small intestine is the best way to diagnose celiac disease.

Screening
Screening for celiac disease involves testing asymptomatic people for the antibodies to gluten. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members--particularly first-degree relatives--of people who have been diagnosed may need to be tested for the disease. About 10 percent of an affected person's first-degree relatives (parents, siblings, or children) will also have the disease. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications.

In Italy, where celiac disease is common, all children are screened by age 6 so that even asymptomatic disease is caught early. In addition, Italians of any age are tested for the disease as soon as they show symptoms. As a result of this vigilance, the time between when symptoms begin and the disease is diagnosed is usually only 2 to 3 weeks. In the United States, the time between the first symptoms and diagnosis averages about 10 years.


What Is the Treatment?

The only treatment for celiac disease is to follow a gluten-free diet--that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed--meaning the villi are intact and working--in 3 to 6 months. (It may take up to 2 years for older adults.)

The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.

A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diets. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease.

If a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.

The Gluten-Free Diet
A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-free bread, pasta, and other products from special food companies.

Whether people with celiac disease should avoid oats is controversial because some people have been able to eat oats without having a reaction. Scientists are doing studies to find out whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician or dietitian's advice about eating oats.

Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Examples of foods that are safe to eat and those that are not are provided below.

The gluten-free diet is complicated. It requires a completely new approach to eating that affects a person's entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, screening for gluten becomes second nature and people learn to recognize which foods are safe and which are off limits.

A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life.


The Gluten Free Diet: Some Examples

Following are examples of foods that are allowed and those that should be avoided when eating gluten-free. Please note that this is not a complete list. People are encouraged to discuss gluten-free food choices with a physician or dietitian who specializes in celiac disease. Also, it is important to read all food ingredient lists carefully to make sure that the food does not contain gluten.

FOOD GROUP ALLOWED NOT ALLOWED
Beverages
Coffee
Coffee, tea, carbonated drinks, wine made in U.S., rum, some root beer Ovaltine, malted milk, ale, beer, gin, whiskey, flavored coffee, herbal tea with malted barley
Milk
Milk
Fresh, dry, evaporated, or condensed milk; cream; sour cream; whipping cream; yogurt Malted milk, some commercial chocolate milk, some nondairy creamers
Meat, Fish, Poultry
Chicken leg
Fresh meats, fish, other seafood, and poultry; fish in canned oil, brine, or water; some hot dogs and lunch meats Prepared meat containing wheat, rye, oats, or barley; tuna canned in vegetable broth
Cheese
Cheese
All aged cheese, such as cheddar, Swiss, edam, parmesan; cottage cheese; cream cheese; pasteurized processed cheese; cheese spreads Any cheese product containing oat gum, some veined cheeses (bleu, stilton, roquefort, gorgonzola)
Potato or Other Starch
Rice
White and sweet potatoes, yams, hominy, rice, wild rice, gluten-free noodles, some oriental rice and bean thread noodles Regular noodles, spaghetti, macaroni, most pachaged rice mixes, seminola, spinach noodles, frozen potato products with wheat flour added
Cereals
Cereal
Hot cereals made from cornmeal, Cream of Rice, hominy, rice; Puffed Rice, Kellogg's Corn Pops, cereals made without malt All cereals containing wheat, rye, oats, or barley; bran; graham; wheat germ; durum; kaska; bulgar; buckwheat; millet; triticale; amaranth; spelt; teff; quinoa; kamut
Breads
Bread
Specially prepared breads using only allowed flours All breads containing wheat, rye, oat, or barley flours and grains listed above
Flours and Thickening Agents
Measuring cup
Arrowroot starch, corn bran, corn flour, corn germ, cornmeal, corn starch, potato flour, potato starch flour, rice bran, rice flour, rice polish, rice starch, soy flour, tapioca starch, bean and lentil flours, nut flours Amaranth, wheat germ, bran, wheat starch; all flours containing wheat, rye, oats, or barley; buckwheat; spelt; quinoa; teff; kamut; millet
Vegetables
Broccoli
All plain, fresh, frozen, or canned vegetables; dried peas and beans; lentils; some commercially prepared vegetables Creamed vegetables, vegetables canned in sauce, some canned baked beans, commercially prepared vegetables and salads
Fruits
Grapes
All fresh, frozen, canned, or dried fruits; all fruit juices; some canned pie fillings Thickened or prepared fruits; some pie fillings; raisins and dried dates that have been dusted with flour
Fats
Butter
Butter, margarine, vegetable oil, nuts, peanut butter, hydrogenated vegetable oils, some salad dressings, mayonnaise, nonstick cooking sprays Some commercial salad dressings, wheat germ oil, nondairy cream substitutes, most commercial gravies and sauces
Soups
Gum drops
Jelly, jam, honey, brown and white sugar, molasses, most syrups, some candy, chocolate, pure cocoa, coconut, marshmallows Commercial candies dusted with wheat flour, butterscotch chips; flavored syrups; sweets containing malt/malt flavorings; some brown rice syrup; some corn syrup
Miscellaneous
Salad dressing
Salt, pepper, herbs, herb extracts, food coloring, cloves, allspice, ginger, nutmeg, cinnamon, chili powder, tomato puree and paste, olives, active dry yeast, bicarbonate of soda, baking powder, cream of tartar, dry mustard, some condiments, apple cider, rice or wine vinegar Curry powder, dry seasonings mixes, gravy extracts, meat sauces, catsup, mustard, horseradish, chip dips, most soy sauce, some distilled white vinegar, instant dry baking yeast, some cinnamon, condiments made with wheat-derived distilled vinegars, communion wafers/bread, some alcohol-based flavoring extracts

Source: Food and Nutrition Services, The University of Iowa Hospitals and Clinics. (1996). Gluten Restricted, Gliadin Free Diet. Iowa City, Iowa: The University of Iowa Hospitals and Clinics.


What Are the Complications of Celiac Disease?

Damage to the small intestine and the resulting problems with nutrient absorption put a person with celiac disease at risk for several diseases and health problems.

  • Lymphoma and adenocarcinoma are types of cancer that can develop in the intestine.

  • Osteoporosis is a condition in which the bones become weak, brittle, and prone to breaking. Poor calcium absorption is a contributing factor to osteoporosis.

  • Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for untreated pregnant women with celiac disease because of malabsorption of nutrients.

  • Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child's normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.

  • Seizures, or convulsions, result from inadequate absorption of folic acid. Lack of folic acid causes calcium deposits, called calcifications, to form in the brain, which in turn cause seizures.


How Common Is Celiac Disease?

Celiac disease is the most common genetic disease in Europe. In Italy about 1 in 250 people and in Ireland about 1 in 300 people have celiac disease. It is rarely diagnosed in African, Chinese, and Japanese people.

An estimated 1 in 4,700 Americans have been diagnosed with celiac disease. Some researchers question how celiac disease could be so uncommon in the United States since it is hereditary and many Americans descend from European ethnic groups in whom the disease is common. A recent study in which random blood samples from the Red Cross were tested for celiac disease suggests that as many as 1 in every 250 Americans may have it. Celiac disease could be underdiagnosed in the United States for a number of reasons:

  • Celiac symptoms can be attributed to other problems.

  • Many doctors are not knowledgeable about the disease.

  • Only a handful of U.S. laboratories are experienced and skilled in testing for celiac disease.

More research is needed to find out the true prevalence of celiac disease among Americans.


Diseases Linked to Celiac Disease

People with celiac disease tend to have other autoimmune diseases as well, including

  • Dermatitis herpetiformis.
  • Thyroid disease.
  • Systemic lupus erythematosus.
  • Type 1 diabetes.
  • Liver disease.
  • Collagen vascular disease.
  • Rheumatoid arthritis.
  • Sjogren's syndrome.
The connection between celiac and these diseases may be genetic.


Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is a severe itchy, blistering skin disease caused by gluten intolerance. DH is related to celiac disease since both are autoimmune disorders caused by gluten intolerance, but they are separate diseases. The rash usually occurs on the elbows, knees, and buttocks.

Although people with DH do not usually have digestive symptoms, they often have the same intestinal damage as people with celiac disease.

DH is diagnosed by a skin biopsy, which involves removing a tiny piece of skin near the rash and testing it for the IgA antibody. DH is treated with a gluten-free diet and medication to control the rash, such as dapsone or sulfapyridine. Drug treatment may last several years.


Additional Resources

American Celiac Society
58 Musano Court
West Orange, NJ 07052
(201) 325-8837

Celiac Disease Foundation
3251 Ventura Boulevard,
#1 Studio City, CA 91604-1838
(818) 990-2354
E-mail: cdf@primenet.com
Web site: http://www.celiac.org/

Celiac Sprue Association/USA Inc.
P.O. Box 31700
Omaha, NE 68131-0700
(402) 558-0600
Web site: http://www.csaceliacs.org/

Gluten Intolerance Group of North America
15110 -10th Avenue, S.W., Suite A
Seattle, WA 98166-1820
(206) 246-6652
E-mail: gig@accessone.com

National Center for Nutrition and Dietetics
American Dietetic Association
216 West Jackson Boulevard
Suite 800
Chicago, IL 60606-6995
(800) 366-1655

Gluten-Free Living (a bimonthly newsletter)
P.O. Box 105
Hastings-on-Hudson, NY 10706


Points to Remember

  • People with celiac disease cannot tolerate gluten, a protein in wheat, rye, barley, and possibly oats.

  • Celiac disease damages the small intestine and interferes with nutrient absorption.

  • Treatment is important because people with celiac disease could develop complications like cancer, osteoporosis, anemia, and seizures.

  • A person with celiac disease may or may not have symptoms.

  • Diagnosis involves blood tests and biopsy.

  • Because celiac disease is hereditary, family members of a person with celiac disease may need to be tested.

  • Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.



National Digestive Diseases Information Clearinghouse

2 Information Way
Bethesda, MD 20892-3570
E-mail: National Digestive Diseases Information Clearinghouse

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.


Vidyya. Home |  Ex Libris |  Vidyya  | 
Subscription Information |  About Vidyya |  Vidyya Archives | 

Vidyya Home |  Home Of Our Sponsor, Vidyya. | Vidyya Archives | Search Vidyya  | Visit Our Library | Subscribe To Our News Service | All About Us | Get Vidyya For Your Website
Editor: Susan K. Boyer, RN
© Vidyya. All rights reserved.