Ailment caused by a reaction to gluten in diet

Celiac disease is a disease of the gut that causes small intestine irritation. Celiac disease occurs due to an immune reaction to gluten in the diet. Gluten is a protein found in wheat, barley and rye. More than 200,000 individuals per year will develop celiac disease in the United States.

When gluten protein is eaten during a meal from a food like wheat bread, the immune system triggers a response to gluten. Even small amounts of gluten, such as residue on a plate, can trigger an immune response in some patients. This is due to the villi, finger-like projections that increase the surface area of the small intestine, becoming flattened after exposure to gluten. With the flattening of the villi, nutrients are less absorbed and diarrhea or abdominal pain may develop. In a normal small intestine, the villi crease a surface area the size of a tennis court in a very small area.

This irritation in the small intestine may cause patients to present with symptoms of abdominal pain, diarrhea, constipation, bloating or gas. Occasionally, patients will have a loose, greasy, bad-smelling stool. Other patients may present with anemia (low iron levels in the blood), osteoporosis (weak bones), an elevation in liver enzymes, low vitamin levels or a particular blistering rash called dermatitis herpetiformis. Celiac disease symptoms can also resemble other diseases that affect the gut. Symptoms from celiac can also be very mild, with very few symptoms or none.

Celiac disease can affect anyone, but Caucasians are more commonly diagnosed. The Punjab region of India is also an area that has a higher incidence of celiac disease. Children and adults may both be affected by celiac disease. Patients with Type 1 diabetes, autoimmune thyroid disease and microscopic colitis are also at risk for developing celiac disease. Family members such as brothers, sisters, parents and children should be tested for celiac disease as the condition may be hidden with no symptoms. Diagnosis of celiac disease is made by a screening blood test for specific labs. An EGD, or esophagogastroduodenoscopy test, is also used to take small tissue samples (biopsy) from the duodenum (first part of the small intestine) that show the flattening of the villi.

The treatment for celiac disease is, first and foremost, to avoid eating gluten and to reduce potential contaminations with gluten containing foods. Dietitians can help patients develop gluten-free diets. Medication is not used to treat celiac disease in most patients. Patients must look very carefully for gluten in foods purchased at food stores or restaurants, as gluten can be found in pasta, breading on foods, marinades, sauces, processed meats and many other foods. Gluten can also be found in many medications and cosmetics. A patient with celiac disease may consider having their home gluten-free to reduce the chance of contamination from stray gluten on kitchen surfaces, cookware and dinnerware.

In many cases, the members of a household should avoid gluten in the home to keep from exposing a patient to gluten. Many restaurants offer gluten-free items for patients with celiac disease. A variety of foods can be used as a substitute for gluten, including rice, corn, potato or quinoa.

For a patient with celiac disease, avoiding gluten is a life-long commitment. Every exposure to gluten (even small amounts) can injure the small intestine. In addition, repeated gluten exposure can increase the risk of lymphoma (a lymph node cancer) or esophageal cancer. Vitamin deficiencies can also easily develop in patients with celiac disease. Iron, vitamin B12, folate, zinc, vitamin D or calcium deficiency can all develop in a patient with celiac disease. Patients at risk for osteoporosis should be screened with a bone density scan (special type of X-ray imaging) that tells how strong the bones are in a patient.

After a diagnosis of celiac disease is made, a patient will need to strictly follow a gluten-free diet for the rest of their lives and follow up with their physician periodically. In some patients, the celiac disease may not get better. For these patients, a review of foods may reveal a hidden source of gluten that could be affecting the small intestine. For vitamin deficiencies, supplements can be provided to the patient to correct these problems.

Many organizations have created patient support groups for patients diagnosed with celiac disease. Another good source for information on celiac disease is the Patient page on the American College of Gastroenterology website, where you can Click “Digestive Health Topics A-Z” and then “Celiac Disease.” This article and other articles are written by practicing gastroenterologists specifically for patients.

James Morris, MD, is an associate professor of medicine in the division of gastroenterology and hepatology in the Department of Medicine and assistant dean for graduate medical education and VA Affairs for the School of Medicine at LSU Health Shreveport.