Celiac disease is a multi system disease in which the gastrointestinal tract is the major site of injury. It is one of the most undiagnosed hereditary autoimmune disorders.
In an autoimmune disease, the body attacks itself. In the case of celiac disease, the body damages or destroys the villi, the very components of the small intestine that enable us to absorb the nutrients we need to survive. And, much like a domino effect, the damage extends to other parts of the body as it progresses.
The trigger for this destructive reaction is gluten, a group of proteins found primarily in wheat, rye, and barley. For those with celiac disease, the immune system treats gluten as a foreign body and inflames the villi of the small intestine in order to protect the body from the perceived invader. The villi, which enable the body to digest and absorb food, inflame and eventually flatten. This can lead to a serious lack of vital nutrients. In some cases, the progress of the reaction is gradual, in others rapid and dramatic.
While we know what triggers the immune response (gluten), the reason why the response occurs only in certain genetically predisposed individuals and at varying times in their lives is still unclear.
What you need to know about celiac disease
Celiac disease is a chronic autoimmune disease which is the result of an immune system response to the ingestion of gluten (a protein found in wheat, rye and barley) in susceptible individuals. This response to gluten damages the small intestine, leading to malabsorption of nutrients and related health issues. To develop celiac disease, a person must inherit the genetic predisposition, be consuming gluten, and have the disease activated. Common activation triggers include stress, trauma (surgeries, etc.) and possibly viral infections. Approximately 10-20% of first-degree relatives of those with celiac disease will have the condition triggered in their lifetime. The disease is permanent and damage to the small intestine will occur every time gluten is ingested, regardless of whether or not symptoms are present.
Celiac disease is a genetic disorder affecting about 1% of people in the USA, Europe and Australia. For every person diagnosed with celiac disease, approximately 80 people have the condition but are undiagnosed.
Classic symptoms are those related to malabsorption and can include: diarrhea, bloating, weight loss, anemia and growth failure. Non-classical symptoms may include a wide range of non-intestinal symptoms including: migraines, infertility, fatigue, joint pain, premature osteoporosis, depression and seizures. Many people do not have gastrointestinal symptoms, some may have just one symptom and some individuals have no obvious symptoms at all.
Initial screening for celiac disease is a blood test ordered by your physician. Blood tests look for the presence of the following antibodies:
- Anti-tissue transglutaminase (tTG)
- Anti-endomysium (EMA)
- Anti-deamidated gliadin peptides (DGP)
Because no one of these tests is ideal, panels are often used.
If this test suggests celiac disease, it is then recommended that a haplotype test for HLA DQ2 and DQ8 be performed to confirm presence of the genes necessary to develop the condition. If this test is positive, a small intestine biopsy is done. A positive small intestine biopsy (showing damaged villi) is the “gold standard” for a diagnosis of celiac disease.
Celiac disease is an inherited autoimmune digestive disease and confirmation of celiac disease will help future generations be aware of the risk within the family.
Strict adherence to a gluten-free diet for life is the only treatment currently available. This means elimination from the diet of wheat, rye, barley and foods made with these grains or their derivatives. Medication is not usually required, unless there is an accompanying condition, such as osteoporosis or dermatitis herpetiformis. Thriving or showing improvement on the gluten-free diet is the second half of the “gold standard” of diagnosis. It may take several months or longer for the small intestine to completely heal. Improvement is measured by regular monitoring of the antibody blood tests used for screening, and by improved health. When you are on a gluten-free diet, blood tests should eventually come back to normal. This indicates good control of celiac disease – not a cure. You will always require a gluten-free diet until another form of treatment is discovered.
The gluten-free diet is a lifelong commitment and should not be started before being properly diagnosed. Starting the diet without complete testing is not recommended and makes later diagnosis difficult. Tests to confirm celiac disease could be negative if a person were on a gluten-free diet for a period of time. For a valid diagnosis to be made, gluten would need to be reintroduced for at least several weeks before testing.
Generally excellent, if a strict gluten-free diet is maintained. The small intestine will steadily heal and start absorbing nutrients normally. You should start to feel better within days; however, complete recovery may take from several months to several years.