So What is Celiac Disease?
Celiac disease is an immune-mediated permanent intolerance to gluten found in wheat, rye and barley. Traditionally considered uncommon, the disease was simply thought of as a gastrointestinal disorder recognized, if at all, in early childhood with the introduction of cereals into the diet. With our growing awareness of the various manifestations of this disease we now understand it to be a relatively common disease affecting approximately 1% of the general U.S. population. Celiac disease is a multi-system disorder and presentation may occur at any age in both sexes under a wide variety of clinical circumstances:
Classic Celiac Disease
Gastrointestinal (GI) Symptoms – Pain;D iarrhea/Constipation; Steatorrhea(fatty, frothy, or foul smelling stools); flatulence; Vomiting; Distention and Weight Loss. Manifestations of malabsorption may include; anemia from iron, folate and B12 deficiencies; coagulopathy from vitamin K deficiency and hypocalcemia from vitamin D deficiency.
Celiac Disease with Atypical Symptoms
Some manifestations may predominate with little or no GI symptoms. A key example is dermatitis herpetiformis characterized by itchy, blistering lesions on the extensor surfaces of the extremities and trunk. Other examples include; iron deficiency anemia that is unresponsive to treatment with oral iron; persistent aphthous ulcers, arthritis, delayed puberty and infertility to name a few. Children may present with behavioral problems including depression, irritability and impaired scholastic performance.
Silent Celiac Disease
Individuals are asymptomatic but have positive blood test and intestinal villous atrophy on biopsy. Diagnosis in these cases most often comes from a routine screening of high risk individuals or biopsy performed for another reason say during a colonoscopy. High risk individuals include for example:
First – and second-degree relatives of individuals with celiac disease.
People with Type 1 diabetes mellitus or other autoimmune disorder.
Down syndrome and other genetic disorder.
Individuals with selective IgA deficiency.
Latent Celiac Disease
Asymptomatic individuals with positive blood tests but no villous atrophy on biopsy. Over time these patients develop symptoms and/ or histological changes. Many of these people may have a long history of imbalanced gut flora, dysbiosis as it is called, and this could be a result or even a potential cause of the problem to begin with some speculate.
There are various blood tests that can be used to screen for this condition which involve investigating for Celiac Antibody Profiles through Serum or whole Blood. If these are inconclusive, “simply” eliminating gluten containing grains in all forms from the diet can be very convincing if it is problematic.