Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found in everyday products such as medicines, vitamins, and lip balms.
When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi –the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats.
Celiac disease is both a disease of malabsorption –meaning nutrients are not absorbed properly- and an abnormal immune reaction to gluten. Celiac disease is also known as celiac sprue, nontropical sprue, and glutensensitive enteropathy. Celiac disease is genetic, meaning it runs in families. Sometimes the disease is triggered –or becomes active for the first time –after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
Symptoms of celiac Disease
Symptoms of celiac disease very from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include
• abdominal bloating and pain
• chronic diarrhea
• vomiting
• constipation
• pale, foul –smelling, or fatty stool
• weight loss
Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.
Adults are less likely to have digestive symptoms and may instead have one or more of the following:
• unexplained iron-deficiency anemia
• fatigue
• bone or joint pain
• arthritis
• bone loss or osteoporosis
• depression or anxiety
• tingling numbness in the hands and feet
• seizures
• missed menstrual periods
• infertility or recurrent miscarriage
• canker sores inside the mouth
• an itchy skin rash called dermatitis herpetiform
People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition –which can lead to anemia, other problems –liver disease, and cancers of the intestine.
Why are celiac disease symptoms so varied?
Researchers are studying the reasons celiac disease affects people differently. The length of time a person was breastfed, the age a person started eating gluten –containing foods, and the amount of gluten – containing foods one eats are three factors thought to play a role in when and how celiac disease appears. Some studies have shown, for example, that the longer a person was breastfed, the later the symptoms of celiac disease appear.
Symptoms also vary depending on a person’s age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing longterm complications.
Other health problems in people with celiac disease
People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may be genetic. They include
• type 1 diabetes
• autoimmune thyroid disease
• autoimmune liver disease
• rheumatoid arthritis
@addison’s disease, condition in which the glands that produce critical hormones are damaged
@sjogren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed
How common is celiac disease?
Celiac disease affects people in all parts of the world. Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder. Among people who have a first –degree relative –a parent, sibling, or child –diagnosed with celiac disease, as many as 1 in 22 people may have the disease.
Celiac disease is also more common among people with other genetic disorders including. Down syndrome and Turner syndrome, a condition that affects girls’ development.
Diagnosis:
Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, irondeficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been underdiagnosed or misdiagnosed. As doctors become more aware of many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.
Blood Tests
People with celiac disease have higher than normal levels of certain autoantibodies –proteinase that react against the body’s own cells or tissues – in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti –tissue transaminases antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.
Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.
Intestinal Biopsy
If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis. During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi.
To obtain the tissue sample, the doctor eases a long, thin called an endoscope through the patient’s mouth and stomach into the small intestine. The doctor then takes the samples using instrument passed through the endoscope.
Treatment:-
The only treatment for celiac disease is a gluten –free diet. Doctors may ask a newly diagnosed person to work with a dietitian on a gluten –free diet plan. A dietitian is a health care professional who specializes in food and nutrition. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods than contain gluten in order to make informed decisions at the grocery store and when eating out.
For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.
To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damages the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.
Some people with celiac disease show no improvement on the gluten –free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.
Allowed foods
Amaranth legumes seeds
Arrowroot millet sorghum
Buckwheat nuts soy
Cassava potatoes tapioca
Corn quinoa teff
Flax rice wild rice
Indian rice grass sago yucca
Job’s tears
Food to avoid:-
Wheat barley
• including einkorn, emmer, rye spelt. kamut
• wheat starch wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein a cross between wheat and rye
Other wheat products
Bromated flour graham flour self –rising flour
Durum flour phosphate flour semolina
Enriched flour farina plain flour white flour
Precessed foods that may contain wheat, barley, or Rye’
Bouillon cubes french fries seasoned
Brown rice syrup gravy tortilla chips self basting turkey
Candy imitation fish soups
Chips/potato chips matzo soy sauce
Cold cuts, hot dogs, rice mixes vegetables
Salami, sausage in sauce communion wafers sauces
Rarely, the intestinal injury will continue despite a strictly gluten free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients directly into their bloodstream through a vein, or intravenously. Researchers are evaluating drug treatments for refractory celiac disease.
• Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
Points to Remember
• People with celiac disease cannot tolerate gluten, a protein in wheat, rye and barley.
• Untreated celiac disease damages the small intestine and interferes with nutrients absorption.
• Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
• A person with celiac disease may or may not have symptoms
• Dysgenesis involves blood tests and, in most cases, a biopsy of the small intestine.
• Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
• Celiac disease is treated by eliminating all gluten from the diet. The gluten –free diet is a lifetime requirement.
• A dietitian can teach a person with celiac disease about food selection, label reading, and other strategies to help manage the disease.
Symptoms of Celiac Disease
The best- known celiac disease symptoms include severe chronic diarrhea with voluminous stools that float in the water, and weight loss to the point of wasting. These symptoms are common infants and young children with celiac disease, who tend to develop bowel symptoms and growth problems shortly after they begin to eat gluten –containing cereals. In fact, it was once though (incorrectly) that celiac disease occurred only in children , and that in most cases the children could outgrow it.
Today we know that celiac disease can begin at any age, persists for life, can involve multiple organs, and that in both children and adults the symptoms of the disease can be extremely variable or there may be no obvious symptoms at all. Because there is no standard “picture’’ of a person with celiac disease, some patients go from doctor to doctor for years seeking a diagnosis for their illness.
The symptoms of celiac disease almost always disappear when the patient follows a strict gluten –free diet. In rare circumstances. When the intestines are so severely damaged by chronic inflammation that they cannot heal even with the gluten –free diet, the patient is said to have unresponsive, or refractory, celiac disease.
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