CELIAC DISEASE

What is Celiac Disease?

An autoimmune disease where the protein gluten damages the villi in the small intestine causing malabsorption.

Celiac Disease is a lifelong condition.

Celiac Disease is also called celiac sprue, nontropical sprue, and gluten sensitivity enteropathy

What is gluten?

Protein found in barley, rye, and wheat

(includes spelt, kamut, and triticale)

What causes Celiac Disease?

Immune system overreacts to gluten

Inflammation of mucosa in small intestine

Unknown cause, still being researched

What are the symptoms?

Classic Symptoms Abdominal distention/Bloating Diarrhea Stomach cramps Gas Constipation Fatty stools

What are the symptoms (cont.)

Fatigue Joint pain Bone loss Depression Weight loss Neuropathy

Skin rash Mouth ulcers Missed menstrual

cycles Infertility

Less Obvious Symptoms

Symptoms in Children

Diarrhea or constipation (or both) Failure-to-thrive Stunted growth Poor appetite or food aversion Vomiting Abdominal distention or bloating Fatigue and irritability Weight loss Iron deficiency anemia Behavior changes Enamel defects of permanent teeth Delayed puberty

photo courtesy of Columbia University

How common is Celiac Disease?

1 in 133 people are diagnosed with Celiac Disease

97% of people with Celiac Disease are not diagnosed!

Prevalence of Celiac Disease has increased in the past 50 years

Can be misdiagnosed as IBS, Crohn’s, Inflammatory Bowel Disease, parasitic infection, or other bowel disorder

Who is at risk?

Those diagnosed with: Type 1 Diabetes Autoimmune Thyroid condition Rheumatoid Arthritis Sjögren’s Syndrome Addison’s disease Down syndrome Microscopic colitis Autoimmune liver disease or hepatitis

How is Celiac Disease diagnosed?

Endoscopy with Intestinal Biopsy

Specific antibody blood tests

Capsule Endoscopy (Camera Pill) – least common

How is Celiac Disease diagnosed?

Endoscopy and Biopsy

Normal

Celiac

American Academy of Family Physicians www.aafp.org

When is Celiac Disease diagnosed?

Elevated anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA) via blood test

Damaged villi (villous atrophy) via biopsy

Celiac Disease can be diagnosed at any age

The longer Celiac Disease goes undiagnosed, risk increases for complications

Additional complications

Deficiencies of Iron, Folic Acid, B-12, calcium, and fat soluble vitamins

Lactose intolerance

Increased risk of GI cancers

Nervous system disorders

Pancreatic insufficiency

Bone loss

How is Celiac Disease treated?

No cure Strict adherence to Gluten-Free(GF)

Diet for life If nutrient deficiencies exist, vitamin

supplements will be needed In severe cases, anti-inflammatory

drugs may be needed to combat intestinal inflammation

New celiac patients should consult with a dietitian about a GF diet plan

What is the GF Diet?Strict Avoidance of all products containing wheat, including wheat bran, wheat germ, semolina, durum, enriched flour, and farina, rye, and barley, including barley malt and malt

While oats are technically gluten-free, they are commonly contaminated with gluten unless tested and labeled as gluten-free oats

What is the GF Diet?

Special care must be taken to avoid gluten in soups, seasonings, sauces, snack foods, processed meats, condiments, and beverages.

Some restaurant chains have GF menus available.

Living with Celiac Disease

With strict adherence to GF Diet, intestinal damage can be healed

Intestinal healing takes 3 to 6 months in children

Healing will take years in adults If improvement is not seen, diet should

be investigated for hidden sources of gluten

Celiac disease is genetic Long-term follow up is recommended

Sources

(2008). Celiac disease (NIH Publication No. 08–4269). Retrieved from National Digestive Diseases Information Clearinghouse website: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac

(2011). Celiac disease. Retrieved from Mayo Foundation for Medical Education and Research website: http://www.mayoclinic.com/health/celiac-disease/DS00319

Celiac Disease Foundation. (2010). Are You the One? [brochure]. Retrieved from http://www.celiac.org/images/stories/PDF/are-you-the-one.pdf

Sources (cont.)

Celiac Disease Foundation. (2010). Is Your Child the One? [brochure]. Retrieved from http://www.celiac.org/images/stories/PDF/is-your-child-the-one.pdf

Presutti, R. J. (2007). Celiac disease. American Family Physician, 76(12), 1795-1802. Retrieved from http://www.aafp.org/afp/2007/1215/p1795.html