What is celiac disease? Celiac disease–also known as coeliac disease, celiac sprue, and gluten sensitive enteropathy–is a genetic autoimmune disorder of the small intestine. When people with celiac disease ingest gluten, their immune systems attack and cause damage to the villi that line the small intestine. These villi, small finger-like protrusions, allow nutrients to be absorbed into the bloodstream. When they are damaged, they can’t absorb nutrients, so you become malnourished, no matter how much you eat. In most cases, eating and maintaining a gluten free diet will reverse this damage and relieve associated symptoms.
How common is celiac disease?
It is estimated that today 1% of the population suffers from celiac disease. Blood samples from the 1950s were compared to similar current day samples, revealing a huge increase between then and now. Since we are not eating significantly more wheat than we have in the past, this change is possibly due to changes in the wheat itself. This could be changes through hybridization, or through processing. Another theory suggests that the change is due to increased hygiene. Our immune systems have fewer external agents to react to, which possibly makes them more likely to attack our own bodies.
What are the symptoms of celiac disease?
Unfortunately, there is no definitive set of symptoms for celiac disease. Different people have different symptoms, and some people have no symptoms at all. Sometimes celiac disease can mimic other gastrointestinal disorders, such as IBS or Chron’s. Gastrointestinal symptoms include:
- Pale, foul-smelling, or fatty stool
- Abdominal pain
- Intestinal gas and bloating
- Abdominal rumbling
- Mouth sores
Celiac disease can also mimic anemia, due to the malabsorption of nutrients in the intestines. Signs of malabsorption include:
- Weight loss with large appetite, or weight gain
- Bone or joint pain
- Easy bruising
- Nose bleeding
- Fatigue or general weakness
- Fluid retention
- Missed menstrual periods
- Infertility or recurrent miscarriage
- Muscle weakness
- Stunted growth (in children), or delayed puberty
- Vitamin B12, D, K, folic acid, or iron deficiencies
- Depression or anxiety
Though weight loss is considered to be a classic symptom of celiac disease, few celiacs are underweight. In addition, almost half are actually overweight.
Other symptoms may include:
- Tingling or numbness in hands and feet (peripheral neuropathy)
- Dental enamel defects
- Skin rash
How is celiac disease diagnosed?
In order to diagnose celiac disease, blood tests are done to check for antibodies. Tests are done for anti-tissue transglutaminase antibodies (tTG-IgA and IgG) or anti-endomysium antibodies (EMA). If these test results are negative but celiac disease is still suspected, tests are done for anti-deaminated gliadin peptide (DGP-IgA and IgG) and total serum IgA. The anti-gliadin antibody (AgA IgG and IgA) test is used for children under 2.
You should have been eating gluten for at least 4 weeks before testing, or the test results will be inaccurate and possibly give a false negative.
If the blood test results are positive, a biopsy of the small intestine is done to confirm the diagnosis. This is generally an outpatient procedure which is done endoscopically. In this procedure, a tissue sample is taken from the small intestine to look for damage to the villi.
If the diagnosis is uncertain, genetic testing can be done to determine whether you are genetically predisposed to celiac disease. This testing will not give a diagnosis, but it will rule it out if the genetic markers are not there.