Celiac disease is a disorder in which the absorptive surface (mucosa) of the small intestine is damaged by a substance called gluten, in genetically susceptible individuals. Gluten is a protein found in certain grains including wheat, rye, barley and triticale. The damage to the intestine results in an inability to absorb nutrients such as protein, fat, carbohydrates, vitamins and minerals, which are necessary for good health.
Celiac disease is a common, chronic gastrointestinal disorder affecting approximately 1 in 100 individuals. Patients with celiac disease can present with a variety of intestinal and non-intestinal symptoms. Common intestinal symptoms are abdominal pain and bloating, chronic diarrhea and weight loss. Other symptoms include fatigue, anemia, bone pain (osteoporosis), mouth ulcers, dental enamel defects, constipation, vomiting, short stature, infertility, menstrual irregularity, increased liver enzymes, migraine headaches and other neurological problems.
In some cases, celiac disease can present only with a chronic, intensely burning and itching rash called dermatitis herpetiformis. There may be no other symptoms present in these patients.
A patient with celiac disease may have one or more symptoms. Sometimes the symptoms can be very mild and non-specific. This is one of the reasons why the diagnosis of celiac disease is often missed.
Blood tests are used to screen for celiac disease. The currently recommended test is IgA tissue transglutaminase antibody. This test is now readily available (all laboratories in Nova Scotia). The confirmatory test for celiac disease is small intestinal biopsy that demonstrates the damage to the mucosa. If blood test is positive, the patient is referred to a gastroenterologist for intestinal biopsy which is taken by endoscopy.
It is very important that the treatment with gluten-free diet NOT be started before the biopsy is done.
At present, there is no cure for celiac disease, although research is going on in this area. Celiac disease can be effectively treated by a strict gluten-free diet. If must be remembered that celiac disease is a permanent disorder and a person does not “outgrow” it. Therefore, the gluten-free diet must be continued for life. Regular follow-up with the physician and dietitian is important.