Celiac Disease, otherwise known as gluten enteropathy or sprue, is a digestive disorder that occurs in some individuals who are exposed to gluten. When people with celiac disease eat gluten their immune system is inappropriately activated damaging the intestinal lining leading to range of digestive and systemic symptoms.
Glutens represent a collection of cereal grains including wheat (gliadins), rye (secalins), barley (hordeins) and oats (avenins). Other cereal grains that are NOT considered glutens including rice (oryzins), corn (zeins), sorghum (sorgnumins) and millet (pennisetins) do not cause Celiac Disease.
People with Celiac Disease can have a variety of symptoms ranging from gastrointestinal complaints including impaired nutrient absorption, abdominal pain, bloating, diarrhea, vomiting, weight loss to non-gastrointestinal systemic issues including developmental delay, anemia, fatigue, pain, arthritis, depression, rash and ulcers. Symptoms vary based on age and degree of inflammation and some people have no active symptoms but are at a high risk of developing symptoms in the future.
Celiac Disease is a genetic disease and appears to be more common in people who have a family history.
Celiac Disease affects people in all parts of the world and in the US it is reported to afflict over 2 million people. Interestingly, it tends to be more common in patients with other genetic disorders including Down Syndrome and Turner Syndrome.
There is a great deal of active research in determining why some people with a genetic disposition develop symptomatic disease while others do not. It appears that breastfeeding, the age of first gluten exposure and the amount of gluten exposure may play a role.
Recognizing celiac Disease can be difficult because some of its symptoms are similar to many other common gastrointestinal diseases including Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). As a result Celiac Disease has long been under diagnosed and misdiagnosed. Dr. Mantas has expertise in this disorder and utilizes a combination of blood tests and intestinal biopsies obtained during upper endoscopy to characterize your risk and degree of Celiac Disease.
Because of malabsorption a variety of long term nutritional complications can occur including anemia and osteoporosis. In addition, Celiac Disease can rarely decompensate into various dangerous disorders including collagenous sprue, ulcerative jejunoileitis and even cancer including enteropathy associated T-cell lymphoma and adenocarcinoma.
People with Celiac Disease also tend to have other immune system disorders including early onset diabetes of the young, autoimmune thyroid disease, autoimmune hepatitis, rheumatoid arthritis, Addison’s disease and Sjogren’s disease. Recognizing these accompanying disorders is important for one’s overall health.
Some people have celiac-like symptoms but do not have Celiac Disease. Common disorders include gluten sensitivity, gluten allergy or another often more serious gastrointestinal condition. Recognizing these disorders is important when trying to alleviate symptoms with treatment.
Avoidance of gluten containing foods is the mainstay of treatment. Interestingly, gluten is also found in many non-food products including medicines, vitamins and lip balms. Fortunately The Food Allergen Labeling and Consumer Protection Act (FALCPA) now requires the U.S. Food and Drugs Administration (FDA) to list potential food allergens and set rules for the use of the term “gluten free” on product labels. Because of these measures and prevalence of Celiac Disease gluten free products are becoming increasingly available in mainstream stores. Nevertheless, the assistance of a dietitian may help in maintaining a gluten free lifestyle.
For most people gluten abstinence allows the intestine to heal and provides symptom relief within a few days. Complete histologic healing of the intestine takes months to even years though. It is important to understand that even the smallest amount of gluten exposure can damage the intestine. In a small fraction of patients a strict gluten free life may not result in symptom resolution. In this instance Dr. Mantas will explore why a patient is non-responsive and assess for complications.
A variety of other disorders can affect the intestine. Suggestive symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, bleeding and weight loss. Please visit Dr. Mantas if you feel that you have an intestinal disorder. Other common intestinal disorders include infectious enteritis, short gut syndrome and intestinal cancer.