Celiac disease is characterized as an autoimmune disease where a patient cannot digest gluten properly. If a patient eats gluten, a protein found in wheat, barley, and rye, it attacks the small intestine and progressively damages the villi, which are small fingerlike projections that line the small intestine to help absorb nutrients. Celiac disease is estimated to affect 1 in 100 people worldwide, and approximately two and one-half millions Americans are undiagnosed, which puts them at risk for long-term complications.

This disease is considered hereditary, which means it tends to run in families. Those with a first-degree relative with celiac disease (first-degree is a parent, child, or sibling) have a 1 in 10 risk of developing celiac disease in the future.

Symptoms of celiac disease include:

• Abdominal pain and bloating
• Vomiting
• Constipation
• Unexplained weight-loss
• Fatigue
• Joint pain
• Delayed puberty and growth
• Chronic diarrhea
• Infertility
• Migraines
• Irregular period

Celiac disease can develop at any age, after a person starts eating foods or taking medicines that have gluten.

The long-term effects of celiac disease

Undiagnosed cases of celiac disease can lead to multiple long-term health conditions and sometimes other autoimmune diseases. In fact, a 1999 study found that those with celiac disease, who are diagnosed with celiac disease at a later age, have a greater risk of developing other autoimmune diseases in the future. Some of these health conditions include:

• Osteoporosis
• Lactose intolerance
• Vitamin deficiencies
• Central and peripheral nervous system disorders
• Infertility and miscarriage
• Iron deficiency anemia
• Gallbladder dysfunction
• GI cancers and intestinal lymphomas
• Neurological disorders, which include epileptic seizures, dementia, migraine, neuropathy, myopathy, ataxia, and multifocal leucoencephalopathy.

Screening and diagnosis

To diagnose celiac disease, patients need to be screened first. There is now a simple blood test available that looks for celiac disease. Typically, those with the autoimmune disorder who eat gluten have a higher-than-normal level of antibodies in their blood. These antibodies were created to attack gluten, because the immune system views it as a threat. In order to have an accurate test, patients must be on a diet that contains gluten.

The Celiac Disease Foundation outlines who should get screened for the disease:

• Children (over 3 years of age) and adults who have celiac symptoms
• Patients with first-degree relatives who have celiac disease
• Individuals who have an associated autoimmune disease or other conditions. This includes type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, autoimmune liver disease, autoimmune thyroid disease, and selective immunoglobulin A (IgA) deficiency.

Children under 3 years of age can also be screened if they are experiencing symptoms beforehand, but antibody testing may not always be accurate.

The Tissue Transglutaminase IgA (tTG-IgA) test is the most common way to screen for celiac disease. The test will be positive in approximately 98% of patient with celiac disease who are on a diet with gluten, while the same test will come back negatively in approximately 95% of patients without celiac disease. If there is a slight risk of a false positive (this comes with patients who have associated autoimmune diseases), then there will be other tests to screen for the disease.

After screening, patients will need an intestinal biopsy to confirm celiac disease. Right now, this is the only way to officially diagnose it.

Treatment for celiac disease is a gluten-free diet

Because celiac disease is a chronic autoimmune disease, you can’t really grow out of it. Celiac disease is a lifelong disease that requires constant management. The only treatment available for celiac disease, and non-celiac gluten sensitivity, is to adhere to a strict gluten-free diet. If a patient were to have gluten, the food or beverage must have less than 20 parts per million (ppm) in order to be adjusted.

Once a patient starts a gluten-free diet, their symptoms usually begin to resolve. And also, following a strict gluten-free diet will help patients avoid health complications.

However, there are other things that a patient should keep in mind. Those with celiac disease are usually deficient in several nutrients, including fiber, iron, calcium, magnesium, zinc, vitamin B12, and vitamin D. Sometimes, healthcare professionals may prescribe or advise patients to take a daily, gluten-free multivitamin to help satisfy nutritional deficiencies. Patients may also be prescribed calcium and vitamin D supplements.

References:

1. https://celiac.org/about-celiac-disease/treatment-and-follow-up/
2. https://celiac.org/about-celiac-disease/what-is-celiac-disease/
3. https://celiac.org/about-celiac-disease/screening-and-diagnosis/
4. https://www.elitecme.com/resource-center/nursing/celiac-disease/