Celiac disease is a disorder in which consumption of gluten (proteins in wheat, barley, and rye, and sometimes in oats) causes the body’s immune system to attack and damage the small intestine.
When people with celiac disease eat food that contains gluten, the lining of the small intestine becomes inflamed. Ordinarily, this lining, called the mucosa, is covered with hairlike projections called villi -- but the inflammation that develops in response to gluten causes the villi to shrink and flatten (or to "atrophy," in medical terms).
Normally, the nutrients in food are absorbed into the bloodstream through the cells on the villi. When the villi become atrophied, there is less surface area for nutrient absorption, and a condition known as malabsorption results. Consequences of malabsorption include vitamin and mineral deficiencies, osteoporosis, and other problems.
There is a strong genetic component to celiac disease. In people who carry the celiac genes, gluten proteins and other environmental factors will sometimes -- but not always -- trigger the disease.
Symptoms of Celiac Disease
The symptoms of celiac disease may begin in infancy, childhood, or adulthood. Some people with celiac disease become violently ill soon after eating just small amounts of gluten. Others have very subtle symptoms, or none at all, and their disease is discovered by accident. Even in symptomatic patients, the diagnosis of celiac disease can take many years, unless the doctor or patient is alert to the possibility that gluten ingestion is to blame.
Diagnosis of Celiac Disease
Unfortunately, no single test can make an absolutely positive diagnosis of celiac disease. Instead, doctors depend on a combination of blood tests to look for certain autoantibodies, as well as a biopsy of the small intestine to look for the villous atrophy that is characteristic of celiac disease.
Traditionally, even when blood tests are positive, a small intestine biopsy is usually done to confirm the diagnosis. It is possible that with the increasing availability of genetic tests to identify individuals who carry the genes for celiac disease, DNA analysis may someday replace the biopsy for confirmation of the blood test findings.
Living with Celiac Disease
Presently, the only treatment for celiac disease is life-long adherence to a strict gluten-free diet: no wheat, barley, rye –- and for the most part, no oats, either, because oats are generally cross-contaminated with gluten from these other grains. This diet is a very difficult one to adjust to –- not only because it requires that so many staples of a normal diet be given up, but also because gluten lurks as a hidden ingredient in so many products. Patients and their families must learn special guidelines for shopping, food preparation, and dining out.
Even in patients who have no symptoms after eating gluten, the strict diet is still important, because even microscopic amounts of gluten are enough to trigger the body’s autoimmune response that damages the intestine. Untreated celiac disease puts patients at risk for serious complications.
Pronunciation: see-lee-ak disease
Also known as: celiac sprue, non-tropical sprue, gluten enteropathy
Sources:
National Institutes of Health Celiac Disease Awareness Campaign.
National Institutes of Health Consensus Development Conference on Celiac Disease.
