When Gluten Attacks: Celiac DiseaseTed J. Paradowski, MD, Gastroenterology and Hepatology

www.SpringfieldClinic.comwww.SpringfieldClinic.com

What is Celiac Disease/Sprue?

• Defined as a permanent intolerance to the storage proteins or gluten found in wheat, rye, and barley

• Chronic (long-term) digestive disease caused by inflammation/irritation of the small intestine

Celiac Disease – Key Points

• Autoimmune disorder

• Ingested gluten is trigger

• Unknown cause – genetics involved

• Inflammation of small intestine

• Blocks absorption of nutrients

• Small increase in mortality + lymphoma

• Lifelong, but treatment straightforward

Celiac Disease – other facts

• About 2 million Americans

• About 1/100 people

• But only 1/10 diagnosed

• 1st degree relatives: 10%

• Type I Diabetes: 2-8%

• Whites >

What is gluten?

• A protein found in wheat, rye, barley

• Technically not in oats, but often contaminated w/other grains

• Examples– Wheat: durum, faro, graham, spelt, kamut, seminola– Wheat starch, bran, germ, cracked wheat– Barley, malt/flavoring, malt vinegar– Rye– Triticale (cross b/w wheat and rye)

Gluten Ingestion in Celiac Dz

Many processed foods contain GLUTEN

• Beer• Bouillon cubes• Candy• Communion wafer• Gravy• Rice mixes• Seasoned tortilla

chips• Soups

• Chips/potato chips• Cold cuts, salami• Hot dogs, sausage• French fries• Matzo• Sauces• Self-basting turkey• Soy sauce

Wide Variety of Symptoms

• Gas, bloating, pain• Chronic diarrhea >

constipation• Foul-smelling stool• Fatty stool• Fatigue• Unexplained anemia• Low iron levels• Behavioral changes;

irritability in children

• Tingling numbness in legs (nerve damage)

• Bone or joint pain• Muscle cramps• Delayed growth • Pale sores in mouth• Specific skin rash,

dermatitis herpetiformis

Diagnosis of Celiac Disease

• Recognize symptoms - overlap• Think of celiac disease• Blood test for autoantibodies

– TTG (tissue transglutaminase) IgA– EMA (endomysial) IgA

• Upper Endoscopy (EGD)– small intestine biopsy

• Do NOT eliminate gluten before testing

Treatment of Celiac Disease

• Gluten-free diet (GFD)

• Strict lifelong adherence

• Dietitian assistance

• Regular interval evaluations– Physician: check blood tests again– Physician: repeat biopsies if needed– Dietitian visits

Some foods without gluten

• Amaranth• Buckwheat• Legumes• Potatoes• Soy• Arrowroot• Corn• Millet

• Quinoa• Tapioca• Brown rice• Flax• Nuts• Seeds• Wild rice

Inadvertent gluten ingestion

• Brown rice syrup• Breading/coating• Energy bars• Flour/cereal products• Imitation bacon• Imitation seafood• Marinades• Panko • Pastas

• Processed lunch meat• Sauces/gravies• Soup bases• Stuffing/dressing• Thickeners• Drugs/OTC meds• Supplements• Kids: Play-dough,

crayons, paint, glue…

Complications of Celiac Disease

• Malabsorption problems– Anemia, growth delay, weight loss,

osteoporosis, infertility

• Refractory – if untreated for years

• Slight increased risk of– Death – SB lymphoma

• Fortunately all can be avoided with GFD

Mimickers

• Pancreatic diseases – loss of enzymes• Small intestinal bacterial overgrowth• Lactase deficiency/lactose intolerance• Intestinal lymphoma• Autoimmune enteropathy• CVID• Tropical sprue• Eosinophilic gastroenteritis

Just to confuse you more…• “Latent” Celiac Disease

– Positive blood antibodies – But normal SB biopsy– Don’t need GFD…yet– Ongoing monitoring, biopsies

• “Silent” Celiac Disease– Positive blood antibodies + abnormal biopsy– But no symptoms– Check for malabsorption– MAY need GFD

Resources for Patients/Families

• www.nlm.nih.gov/medlineplus/celiacdisease.html - The National Library of Medicine

• www.celiac.org – The Celiac Disease Foundation• www.gluten.net – Gluten Intolerance Group of NA• www.csaceliacs.org – The Celiac Sprue Association• www.americanceliac.org – American Celiac Dz Alliance• www.celiacawareness.org – National Foundation for

Celiac Awareness (NFCA)• About.com Celiac disease forum

– http://celiacdisease.about.com/forum

Questions?