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Celiac disease is a chronic digestive disease caused by gluten consumption. Gluten is a protein found in wheat, barley, rye, and sometimes oats. Gluten can even be found in some medicines, vitamins, and cosmetics.

If you have celiac disease, gluten consumption triggers an autoimmune response in the small intestine. Over time, this reaction damages the lining of the small intestine and prevents it from absorbing nutrients (malabsorption). Intestinal injuries can lead to serious complications.

Celiac disease can develop at any age after gluten-containing products or gluten-containing medicines are introduced into the diet. In children, malabsorption may affect growth and development, in addition to the symptoms seen in adults.

The only treatment for celiac disease is to follow a strict gluten-free diet. If celiac disease does not improve after at least a year without gluten, it is called refractory celiac disease.

Celiac disease is not the same as gluten intolerance or gluten sensitivity. People with gluten intolerance do not have an autoimmune response or small intestine damage.

CAUSES OF CELIAC DISEASE

The exact cause of celiac disease is unknown. Celiac disease is an autoimmune disease. When a person with celiac disease eats gluten, the cells and the immune system are activated and attack the small intestine. The small intestine is no longer able to effectively absorb nutrients, no matter how much they eat.

Sometimes celiac disease becomes active after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

RISK FACTORS FOR CELIAC DISEASE

Celiac disease tends to be more common in people who have:

  • A family member with celiac disease or herpetiform dermatitis
  • Type 1 diabetes
  • Addison’s disease
  • Down syndrome or Turner syndrome
  • Rheumatoid arthritis
  • Multiple sclerosis (MS)
  • Autoimmune hepatitis
  • Lupus
  • Irritable bowel syndrome
  • Chronic pancreatitis
  • Psoriasis
  • Scleroderma
  • Lactose intolerance
  • Intestinal cancer

TYPES OF CELIAC DISEASE

Celiac disease is divided into three types, each with its own symptoms.

  • Classical celiac disease: Food nutrients are not absorbed as they should be.
  • Non-classical celiac disease: No symptoms of nutrient absorption, but other symptoms, conditions, and autoimmune diseases appear.
  • Silent celiac disease (also known as asymptomatic celiac disease): There are no symptoms, but the small intestine is still damaged.

SYMPTOMS OF CELIAC DISEASE

There are over 200 known symptoms of celiac disease that can occur in the digestive system or other parts of the body. Children and adults tend to have different symptoms.

Symptoms in children and adolescents

  • Gastrointestinal symptoms such as abdominal pain, swollen abdomen, chronic diarrhea, constipation, gas, nausea, vomiting, and bloating
  • Fatigue
  • Growth problems
  • Delayed puberty
  • Small stature
  • Damage to tooth enamel
  • Weight loss
  • Irritability and behavioral problems
  • Anemia
  • Neurological symptoms including learning disabilities, ADHD, headaches, lack of muscle coordination, and seizures
  • Herpetiform dermatitis (itchy rash)
  • Iron deficiency anemia

Symptoms in adults

  • Gastrointestinal symptoms such as abdominal cramps, diarrhea, constipation, gas, nausea, vomiting, and bloating
  • Persistent hunger
  • Fatigue
  • Weight loss
  • Iron deficiency anemia
  • Nutritional deficiencies, including lack of vitamins B12, D, and K
  • Osteoporosis and osteomalacia
  • Joint pain
  • Herpetiform dermatitis (itchy rash)
  • Mouth ulcers
  • Headache or migraines
  • Reduction of spleen function (hyposplenism)
  • Liver disorders such as fatty liver
  • Irregular menstruations
  • Numbness and tingling in the feet and hands (peripheral neuropathy)
  • Depression, irritability, and panic attacks
  • Fluid retention
  • Infertility or miscarriages

DIAGNOSIS OF CELIAC DISEASE

Many people with celiac disease do not know they have it. So, it can take years to get a diagnosis.

The diagnosis begins with a physical examination and a medical history.

To help diagnose celiac disease, your doctor will recommend:

  • Serology tests: These tests check for the presence of certain antibodies in the blood. People with celiac disease often have high levels of anti-endomysium antibodies and anti-tissue transglutaminase antibodies. The tests are conclusive when performed during a diet containing gluten. If you are already on a gluten-free diet, your doctor will suggest a ″gluten challenge″ before doing these tests. You will eat at least four slices of wheat bread every day for eight weeks.
  • Genetic tests: HLA-DQ2 and HLA-DQ8 genes are tested. If you do not have them, you are very unlikely to have celiac disease.

If the results of these tests indicate celiac disease, your doctor will suggest one of the following investigations:

  • Upper digestive endoscopy: This procedure will allow the doctor to check for small intestine lesions. It is inserted a long tube (called an endoscope) with a tiny camera attached to it, through the mouth and throat, then into the esophagus, stomach, and upper small intestine. The endoscope allows the doctor to take a tissue sample (biopsy) to look at the damage to the lining of the small intestine. For the endoscopy to be correct, you need to follow a diet containing gluten.
  • Endoscopic video capsule: The investigation consists of recording images from the digestive tract (esophagus, small intestine, colon) using a capsule the size of a pill, equipped with one or two cameras, a light source and a battery lasting 8-10 hours. During this time, the capsule will transmit about 4 images/second, which are captured by a small device attached with a belt to the patient’s body.

If your doctor suspects that you have herpetiform dermatitis, they may take a sample of skin tissue to examine under a microscope (skin biopsy).

TREATMENT OF CELIAC DISEASE

Currently, the only way to treat celiac disease is to avoid gluten for life. Even traces of gluten in your diet can be harmful, even if they do not cause symptoms.

Eliminating gluten from your diet will gradually reduce inflammation in the small intestine, helping it to heal and begin to absorb nutrients properly.

Once you start a gluten-free diet, your symptoms should improve in a few weeks. It is possible that the small intestine will heal in a few years. Children tend to heal faster than adults.

If your anemia or nutritional deficiencies are severe, your doctor or dietitian may recommend that you take supplements and they will teach you how to have a nutritious and healthy gluten-free diet.

If you want to find out more about celiac disease, visit Celiacs.net – Gluten Free Lifestyle and Celiac Disease Tips.

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