Celiac Disease (Celiac Sprue, Nontropical Sprue, Gluten-Sensitive Enteropathy)

Definition

Celiac disease is an autoimmune disease affecting the digestive tract. In susceptible people, eating food with gluten damages little protrusions in the small intestine (called villi) that absorb nutrients. The condition affects absorption of all nutrients, not just those in foods with gluten, so untreated patients often become malnourished. Gluten is found in wheat, rye, and barley.

Causes

Doctors do not fully understand what causes celiac disease, but eating gluten seems to be involved. Most likely, patients whose immune systems are genetically predisposed develop the disease after exposure to gluten. There is some evidence that, in such people, earlier exposure in infancy causes more severe disease than later exposure.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Family members with celiac disease
• History of another autoimmune disease, such as:
  
  • Type 1 diabetes
  • Autoimmune thyroid disease
  • Lupus
• Dermatitis herpetiformis—a skin condition associated with celiac disease
• Rheumatoid arthritis

Symptoms

Symptoms vary and may start in childhood or adulthood. Children often have different symptoms than adults. Symptoms may not develop if a large section of the intestine is undamaged. Malnutrition may produce the first signs of the condition, which are often the most serious.

Signs and symptoms may include:

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Symptoms of celiac disease are similar to those of other conditions. It may take a long time to get an accurate diagnosis. Yet early diagnosis and treatment reduce the risk of complications.

Tests may include:

• Blood tests—to detect the presence of gluten antibodies (produced by the immune system) and look for evidence of malabsorption (anemia, vitamin and mineral deficiencies)
• Stool tests—to check for evidence of malabsorption
• Endoscopy—a thin, lighted tube inserted down the throat to examine the intestine
• Biopsy —removal of a small sample of tissue during endoscopy to test for inflammation and tissue damage
• Repeat biopsy—a biopsy performed several weeks after treatment begins to confirm the diagnosis

Treatment

A life-long, gluten-free diet is the only treatment for celiac disease. Fortunately, it is extremely effective. Symptoms usually go away within days of starting the diet, though healing of the villi may take months or years. Additional intake of gluten can damage the intestine, even if you have no symptoms. Delayed growth and tooth discoloration may be permanent. Nutritional supplements, given through a vein, may be needed if the intestinal damage is significant and does not heal. Since gluten is added to many foods, the diet can be complicated and often frustrating. Some patients find support groups helpful.

Prevention

There are no guidelines for preventing celiac disease because the cause is not understood. If celiac disease runs in your family, ask your doctor about a screening test. The earlier you start the gluten-free diet, the less damage there will be to the intestine.