Gastrointestinal Diseases
Celiac
 

Overview:

  • Celiac is an autoimmune disease that causes the body to attack the small intestine as a result of ingesting gluten-containing foods.
  • The cause of celiac remains unknown, but there are risk factors that could its onset more likely.
  • Most of the problems associated with celiac involve slowed growth and malnutrition due to bowel damage.
  • Celiac complications only affect people who continue to eat gluten.
  • There is no cure for celiac. You should follow a gluten-free diet if you have this disease.

What is allergy?
Allergy is the immune system's reaction to certain substances (e.g. pollen, mites, fungi, some foods, etc.) which do not usually affect normal people.

The Immune system usually attacks harmful objects that enter the body. In the case of allergy, though, the immune system misperceives some normal substances as being harmful (receives a false alarm), and attacks them by producing antibodies (such as histamine), which causes allergy symptoms. The person suffering from an allergy is usually sensitive to more than one substance.

What is food intolerance? 
It is the body's inability to digest a certain type of food. It also means that a type of food causes gastrointestinal upset. Its symptoms may resemble those of an allergy, but it does not result in an anaphylactic shock.

What is gluten? 
Gluten is a protein often found in wheat and barley.

Non-celiac disorders:
  • Non-celiac gluten sensitivity
  • Wheat allergy

Celiac disease (CD)
Celiac is a chronic autoimmune disease (not an allergy). When a person with celiac consumes food that contains gluten, the immune system responds by attacking the small intestine. This leads to damage to the villi (the projections that line it) over time. These projections are responsible for absorbing nutrients from food.  When they are damaged, the nutrients do not get properly absorbed by the body.

Other names:
Coeliac disease, celiac sprue, and gluten sensitive enteropathy

Non-celiac gluten sensitivity:
  • It is a case where individuals cannot tolerate gluten and experience symptoms similar to the symptoms of celiac yet would not test positive for CD.
  • Its symptoms are similar to those of CD. 
  • It does not have a specific diagnosis, but initially, CD examinations are performed on the sick individuals to exclude CD. Afterwards, they are given products that contain gluten so the appearance and disappearance of symptoms can be monitored.
  • There is no cure for it. It is often enough for the person with symptoms to simply avoid products that contain gluten.

The difference between CD and non-celiac gluten sensitivity:
CD leads to damage to the villi that lines the small intestine, while non-celiac gluten sensitivity does not cause that. 

Wheat allergy:
  1. A wheat allergy is the immune system’s reaction to the proteins found in wheat only, not the gluten found in other foods.
  2. It is classified as a type of allergy rather than an autoimmune disease like celiac.
  3. Its symptoms are different from CD and non-celiac gluten sensitivity. They range from mild (such as itching, rash, stomachache, and swelling of the lips and tongue) to severe (such as difficulty breathing, loss of consciousness, and anaphylactic shock).
  4. There is no cure for it; however, a person with wheat allergy should simply avoid products that contain wheat of all kinds, as it could be life threatening. 

Cause:
The cause of the disease, as well as the range of symptom severity among people who have it, is still unknown.

Risk factors:
Anyone can get the disease; however, your chances of developing it increase in the following cases:
  • A family history of celiac disease;
  • Genetics;
  • Down syndrome or Turner syndrome;
  • Having other autoimmune diseases, such as: Type 1 diabetes.
  • Environmental factors, such as: A child catching infections like Rotavirus, or infants being fed gluten-containing food before reaching the age of 3 months.

People with CD are at higher risk to have one of the following diseases:
  • Osteoporosis;
  • ​Anemia due to iron deficiency;
  • Type 1 diabetes;
  • ​Thyroid disorders;
  • Dermatitis herpetiformis; 
  • Nervous system disorders;
  • Liver diseases.

Symptoms:
Some mild cases may not cause any symptoms; however, a diagnosis may confirm celiac disease. For some people, the symptoms may appear after consuming gluten for the first time. For others, they may appear after consuming gluten several times. The symptoms may include:
  • Diarrhea (the most common symptom);
  • Disorders in the digestive system and kidneys, such as: nausea, stomach cramps, vomiting, bloating and constipation;
  • Loss of appetite;
  • The appearance of fats with feces; as they may not be absorbed into the body;
  • Fatigue and tiredness due to the poor absorption of vitamins and nutrients;
  • Unexplained weight loss.

When to see a doctor?
You should see your doctor if you start noticing the symptoms above. Other signs you should see your doctor for include:
  1. ​The diarrhea or digestive problems persisting for more than two weeks.
  2. Your child having growth problems and a pale face.
  3. Your belly bloating and swelling, with a noticeable change in the consistency and smell of stool.

Complications:
Complications of CD only affect people who continue to consume gluten, whether it goes undiagnosed, or if it results in mild symptoms. The complications include:
  • Osteoporosis;
  • Malnutrition;
  • Iron deficiency anemia;
  • Deficiency  of vitamin B12, folic acid, and vitamin D;
  • Lactose intolerance, as CD might damage the part of the intestine responsible for digesting lactose.
  • In pregnant women: Low birthweight; 
  • Some types of cancer, such as: Small bowel cancer (in very rare cases).

Diagnosis:
Make sure to see your doctor and get examined for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet might affect the results of your blood tests. Celiac examination includes:
  • Family history
  • Lab tests (especially blood tests).
  • A biopsy taken from the small intestine if the blood test results are positive.

A celiac test is recommended if a family member has it, or if you have risk factors yourself. Parents or grandparents could have CD without showing symptoms.   It is also recommended to undergo lab tests 3-6 months after diagnosis. Then you should undergo them annually for life to remain aware of changes. 

Treatment:
There is no cure for celiac; however, a strict, lifelong gluten-free diet can help manage it and avoid its complications. Patients who test positive for celiac must go on a healthy gluten-free diet, even if they show mild symptoms or no symptoms at all. They are often still prone to celiac complications. 

Prevention:
There is no way to prevent celiac, but the following guidelines are recommended to avoid complications:
  • Follow a healthy diet and regularly see your gastroenterologist for follow up.
  • See a dietitian to help you maintain a convenient diet.
  • It may be difficult to choose the right food at first, but it will get easier with time.
  • Make sure to read ingredients before eating or giving food to a child. Make sure the ingredients do not contain gluten.
  • Teach your child to read the label on his/her food. Make sure they know the various names of gluten.
  • Just because a food product is free of wheat does not mean it has no gluten. It may contain other ingredients that contain gluten.
  • Beware of passing some foods containing gluten indirectly into the food of a child with celiac disease. This is why it is extremely necessary to wash your hands thoroughly after cooking food that contains gluten before you start cooking gluten-free food.
  • When eating out, inform your waiter of celiac disease.
  • Your nutritionist or dietitian may recommend that you take the following nutritional supplements as needed: Calcium, folate, iron, vitamin B12, vitamin D, vitamin K, and zinc.
  • Joining experience-sharing groups can help you receive moral support. 

Celiac and diabetes: 
  1. Celiac is more likely to affect people with type 1 diabetes.
  2. Once you are diagnosed with type 1 diabetes, you should get checked for celiac disease and vice versa.
  3. No link between celiac and type 2 diabetes has been found.
  4. Failure to follow a celiac treatment plan for people with type 1 diabetes may damage the projections that line the small intestine. This may lead to hypoglycemia, because the small intestine may not be able to adequately absorb nutrients, such as sugar.

FAQ:
  • Do gluten free products help with weight loss?
    • A gluten free diet has nothing to do with weight loss in healthy people. People who do not have celiac are advised  to avoid a gluten-free diet. Their bodies need all the nutrients found in all kinds of food. However, a gluten-free diet may cause people with celiac disease to gain weight.
  • If I stick to a gluten-free diet, will the projections in my small intestine heal?
    • Yes, they will heal if you stick to a strict gluten-free diet. 
  • Why are people with type 1 diabetes more prone to celiac?
    • Because autoimmune diseases are one of the risk factors that could increase your chances of developing celiac.
  • Is celiac a genetic disease?
    • Genetics are one of the risk factors that could increase your chances of developing the disease.
  • It is recommended that infants do not consume wheat until they are at least 1 year old. Does this have to do with celiac disease?
    • Feeding infants food that contains gluten before the age of 3 months is a risk factor that can increase their chances of developing the disease later in life. However, it is generally recommended to introduce solid foods to an infant's diet after the sixth month, especially foods that contain gluten.

Myths & Truths:
  • Gluten is found in food only.
    • Truth: Gluten can be found in other products, such as: Lipstick products, mouthwash, toothpaste, herbal and nutritional supplements, play dough, and some medications.
  • Celiac is contagious.
    • Truth: This is incorrect. Celiac disease is not contagious. 

 
Clinical Education General Department
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Last Update 07 September 2020 04:39 AM
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