Celiac Disease

Celiac disease, also known as non-tropical sprue, celiac sprue, or gluten-sensitive enteropathy, is an autoimmune disease. It is caused by the body's immune system reacting to gluten and its derived peptides like gliadins. Gluten is broadly termed protein found in wheat, rye, and barley that is part of most meals, including pasta, cakes, breakfast cereals, and most types of bread and sauces.
 The hypersensitive inflammatory response occurs in the small intestine, damaging the intestinal mucosal brush border and resulting in malabsorption. Consequently, deficiency of essential nutrients leads to clinical diagnosis. Several risk factors can speed up the process of manifesting the disease, for example, family history, a mutation in the HLA-DRQ gene, and rotavirus infection in childhood, or it can be completely idiopathic.

A combination of genetic and environmental factors is thought to be responsible for the disease, although the exact cause is still unclear. A person is more likely to have the condition if they have a family member with the disease. The environmental factors that can trigger the disease may include gastrointestinal infections, surgery, viral infection, pregnancy, childbirth, or severe emotional stress.
The inflammation destroys the small intestine’s villi, resulting in severe nutritional deficiencies. Villi are finger-like projections in the small intestine responsible for the absorption of food.

Celiac disease is prevalent worldwide. It is most commonly found in western Europe and the United States. Its incidence is now increasing in Africa and Asia. The disease is more prevalent in females than males. The disease may affect you in two age categories. One is 8-12 months, and the other is 30-40 years.

Following factors may increase your chances of having the disease;

• If you have any family member with an autoimmune condition.
• If you suffer from any other autoimmune disease such as diabetes type 1, Addison's disease.
  People with Turner syndrome or Downs syndrome.
• Colitis due to other causes like lymphocytic or collagenous.

The case of celiac sprue presents clinically with the following symptoms and signs:

• Abdominal pain
• Chronic diarrhea or constipation
• Nausea and vomiting
• Bloating and flatulence
• Weight loss
• Anemia
• Peripheral neuropathy
• A rash, known as dermatitis herpetiformis
• Joint pain
• Mouth sores
• Delayed puberty
• Depression

Children can present with failure to thrive, mood changes and delayed growth and height, damaged tooth enamel, and late-onset puberty. It is also related to other conditions, including various autoimmune diseases like Hashimoto thyroiditis, Sjogren's syndrome, hormonal disturbances, osteoporosis, skin changes, and neurological manifestations like ataxia and seizures.

Initially, routine tests are not advised unless there are symptoms and risk factors for developing celiac disease. Diagnosis is based on various hematologic tests, including a complete blood picture showing low hemoglobin and serum iron levels. Stool examination shows fat malabsorption, and on serology immunoglobulin, A (IgA) antibodies are found. However, the diagnosis is confirmed on a biopsy of the specimen from the luminal surface of the small intestine. It shows total villous atrophy and markedly abnormal epithelial cells with increased intraepithelial lymphocyte and plasma infiltrate in the lamina propria with cryptic hyperplasia. While being tested for it, the patient is advised to continue eating a diet containing gluten until its diagnosis is confirmed. Tests will create biased results while the patient is on a gluten-free diet.

The treatment of celiac disease consists of eliminating gluten and its derivatives entirely from the diet. This prevents the small intestinal lining from being damaged by the body’s immune system, and the symptoms like diarrhea and stomach pain disappear gradually. Sometimes symptoms take almost 2 years to heal completely.  Ideally, the patients are referred to a dietician who guides them about a gluten-free diet and covers the deficit created due to malabsorption of nutrients. Foods like potatoes, meat, vegetables, cheese, and rice are free from gluten. Along with a selective diet, multi-nutrient supplements for six months are also advised after the diagnosis.
Due to overactive immune responses, people with celiac disease are more susceptible to infections like influenza, pneumonia, and meningitis. Therefore, vaccinations are recommended for other conditions that could occur concomitantly.
A refractory type of celiac disease is when the symptoms persist even after taking a gluten-free diet. The cause is investigated to exclude any differentials. The doctor then would advise steroids such as prednisolone to combat the disastrous effects of the immune system.

Celiac disease is incurable; however,  the multimodal approach of restricting gluten from the diet and supplementing the diet with the nutrients can improve overall life quality in patients. The patients who strictly follow the treatment can have an excellent prognosis and live a normal life.
The refractory cases have a poor prognosis. People are at increased risk of certain malignancies like adenocarcinoma of the intestinal tract and lymphomas. Several complications can occur in untreated celiac disease like severe malnutrition, anemia, slowed growth in children, dehydration, osteoporosis, miscarriages, seizures, and peripheral neuropathy.

Here are some tips to help you cope with celiac disease;

• Gather all the information about your condition.
• Share your knowledge with the family members to let them know and help you manage.
• Follow a strict gluten-free diet that should not include cereals, packaged foods, pasta, baked goods, beers, rice, processed foods, soups, and gravies, processed meat. 
• Take a nutritious amount of food that is allowed that includes, Eggs, Fresh meats, fish, and non-breaded poultry, Lentils, Potatoes, Vegetables, fruits, nuts, wine,
• Join support groups on social media to meet people with similar symptoms.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 14, 2023. 

References

Celiac Disease - NIDDK (nih.gov)

https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease#:~:text=Celiac%20disease%20is%20a%20chronic,all%20the%20nutrients%20it%20needs.

Celiac disease in children: A review of the literature - PMC (nih.gov)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290992/