Celiac disease is a condition in which the lining of the small intestine is damaged and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.
Causes, incidence, and risk factors:
The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi. This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.The disease can develop at any point in life, from infancy to late adulthood. Gluten is a protein present in wheat, barley, rye, cereals and their products.
People who have a family member with celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men.
People with celiac disease are more likely to have:
- Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome
- Addison’s disease
- Down syndrome
- Intestinal cancer
- Intestinal lymphoma
- Lactose intolerance
- Thyroid disease
- Type 1 diabetes
Symptoms of celiac disease:
Depending on the degree of malabsorption, the signs and symptoms of celiac disease vary among individuals, ranging from no symptoms, few or mild signs and symptoms, to many or severe signs and symptoms. There are two categories of signs and symptoms: 1) those due to malabsorption, and 2) those due to malnutrition including vitamin and mineral deficiencies.
Gastrointestinal symptoms due to malabsorbtion include:
- Abdominal pain, bloating, gas, or indigestion
- Decreased appetite
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss
Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time due to malnutrition:
- Easy Bruising (Lack of absorption of vitamin K can lead to diminished ability of blood to clot and hence to easy bruising or excessive bleeding).
- Anemia (Lack of absorption of vitamin B12 and iron can lead to anemia).
- Depression or anxiety
- Growth delay in children
- Hair loss
- Itchy skin (dermatitis herpetiformis)
- Irregular menstruation
- Ulcers in mouth and tongue
- Muscle cramps and joint pain(Lack of absorption and low levels of potassium and magnesium can lead to severe muscle weakness, muscle cramps, and numbness or tingling sensations in the arms and legs).
- Bleeding from nose and gums
- Unexplained short height
- Osteoporosis: Lack of absorption of vitamin D and calcium can lead to osteoporosis and bone fractures.
- Peripheral neuropathy (nerve damage): Vitamin deficiencies of B12 and thiamine may contribute to nerve damage with symptoms of poor balance, muscle weakness, and numbness and tingling in the arms and legs.
- Infertility: Untreated celiac disease can lead to infertility in women, lack of menstruation, spontaneous abortions, and low birth weight infants.
Children with celiac disease may have:
- Defects in the tooth enamel and changes in tooth color
- Delayed puberty
- Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting
- Irritable and fussy behavior
- Poor weight gain
- Slowed growth and shorter than normal height for their age
Do symptoms of celiac disease vary depending on age?
Infants with celiac disease typically have diarrhea, fat in the stool (steatorrhea), abdominal cramps, abdominal distension, irritability, muscle wasting, and failure to thrive and grow. These symptoms typically occur after introduction of gluten-containing cereals into their diets.
Children with celiac disease typically have diarrhea, steatorrhea, flatulence (passing gas), short stature, and weight loss. Proper treatment with a gluten-free diet can lead to accelerated (catch-up) growth in height; however, if untreated, childhood celiac disease can result in short stature as an adult. As children with celiac disease enter adolescence, many will experience spontaneous remissions (reduced symptoms) and remain free of the signs and symptoms of celiac disease until later in adulthood. This later reactivation can be precipitated by stress such as pregnancy or surgery.
Adults with celiac disease may have symptoms of diarrhea, steatorrhea, weight loss, and flatulence; however, many adults do not have diarrhea or steatorrhea. They have either no symptoms or only vague abdominal discomfort such as bloating, abdominal distension, and excess gas. They also may have only one, or only a few signs of malnutrition such as iron deficiency anemia, abnormal bleeding, or bone fractures. Some patients with celiac disease and gastrointestinal symptoms are mistakenly diagnosed with irritable bowel syndrome.