Celiac Disease

Celiac Disease

What Does Celiac Disease Have To Do With IBS?

Many people with celiac disease were previously diagnosed with irritable bowel syndrome (IBS). It is because these conditions have overlapping symptoms. Some of these symptoms are diarrhea, constipation, abdominal (belly) pain, and bloating.

What Is Celiac Disease?

Celiac disease is a chronic (long-term), autoimmune (immune system attacks body) condition. It is due to a reaction to the protein gluten in the diet. A reaction occurs when a person with celiac disease eats gluten-containing foods - wheat, barley, and rye. Although it is considered a digestive disease, other organs and body systems may also be affected.

In celiac disease, the immune system attacks the walls of the small intestine causing irritation and inflammation. The villi, which are small projections that line the intestines, are damaged. The villi are important for digestion and absorption of nutrients. Because of the changes in the intestines, malabsorption occurs, i.e. a person cannot fully absorb the nutrients in food

How Common Is Celiac Disease?

Celiac disease has become more common over the last several decades. In the last 10 years, it has also been diagnosed much more often.

Some studies have found close to 1 out of 100 children and adults have celiac disease. However, only 1 out of 5 people with celiac disease are diagnosed.

  • Celiac disease is more common in women compared to men. Of those diagnosed, they’re usually in their late 30s or older.

  • Celiac disease is dependent on the presence of specific genes - HLA DQ2 or DQ8. Since it is genetic, it is passed down through families. Thus, a person is at increased risk of developing celiac disease when other family members have the condition

  • People with other autoimmune conditions also have an increased risk of celiac disease; for example, type 1 diabetes and autoimmune thyroid disease.

What Are The Symptoms Of Celiac Disease?

Symptoms of celiac disease may be mild, moderate, or severe. Although uncommon, some people have no symptoms (found with screening for celiac disease or testing for other conditions). Regardless of the severity, damage may be occurring in the small intestine. 

Symptoms affect the gastrointestinal (GI) system, as well as other body systems. GI symptoms include the following:

  • Diarrhea (most common symptom)

  • Constipation

  • Fatty, pale, bad-smelling stool

  • Bloating (a feeling of fullness in the abdomen [belly])

  • Abdominal pain

  • Weight loss

  • Fatigue or tiredness

Other signs and symptoms include:

  • Abnormal liver function tests

  • Iron deficiency anemia (low blood iron level)

  • Osteoporosis (reduced bone density or weakened bones)

  • Dermatitis herpetiformis (chronic skin inflammation with itchiness, redness, blisters, most often affecting elbows, knees, buttocks)

How Is Celiac Disease Diagnosed?

Part of the diagnosis of celiac disease is a review of the person’s symptoms and medical history by their doctor.  It’s also important to know if any family members have celiac disease. 

Diagnostic tests

A person should not reduce or avoid gluten before diagnostic tests are performed. This may affect the results.

  • Antibody tests are used to screen for celiac disease. Of the antibody tests, the tissue transglutaminase antibody (tTG), IgA is the preferred test. It may also be used to monitor the course of the condition and the effectiveness of treatment. 

  • A duodenal mucosal biopsy is done to confirm the diagnosis of celiac disease. An endoscope is passed through the person’s mouth, esophagus, and stomach and into the small intestine. Samples of the lining of the duodenum, the first part of the small intestine, are taken.

The duodenal mucosal biopsy is the gold standard for confirming celiac disease.

How Is It Treated? What Is A Gluten-Free Diet?

Celiac disease is treated with a strict gluten-free diet. It is accomplished by eliminating gluten protein found in wheat, barley, and rye. 

Gluten-free means removing all gluten from the diet. However, it is not possible to remove all gluten since some foods have very small amounts of it. So, gluten-free really means a diet with harmless levels of gluten. 

Although the exact amount of gluten considered harmless is uncertain, it is believed to be less than 10 mg per day

Following a gluten-free diet is challenging. Guidelines for the treatment of celiac disease recommend the support of a dietitian, who will:

  • Teach the gluten-free diet

  • Educate about identifying gluten - i.e. label reading

  • Help with gluten-free meal planning

  • Evaluate for possible nutrient deficiencies

  • Monitor for adherence to the diet

  • Provide ongoing counseling, support, and resources

Why Is A Gluten-Free Diet Important?

A gluten-free diet is the only treatment for celiac disease. The diet decreases inflammation in the small intestine. By doing so, symptoms are lessened or eliminated

A person who does not follow a gluten-free diet is likely to have continued or increasing symptoms. Ongoing or worsening complications from malabsorption and nutrient deficiencies are also likely. Complications may include: anemia; inflammation of the liver; decreased bone density and risk for fractures; and infertility.

For More Information

American College of Gastroenterology (2021). Celiac Disease. Retrieved 11-28-2022 from https://gi.org/topics/celiac-disease/.