Celiac disease affects an estimated two million Americans and makes them unable to tolerate the protein gluten, found in wheat, rye, and barley. David Elliott, MD, PhD, director of the celiac and inflammatory bowel disease clinic at University of Iowa Hospitals and Clinics, talks about celiac disease:
What happens with celiac disease? What does it do to the body?
Let me first state that celiac disease is actually fairly common. We think about one in every 150 people or so has celiac disease and most of these people are completely unaware that they have the disease. That’s why it’s really important to get these messages out.
A person with celiac disease develops intestinal inflammation, which is like a rash that involves the lining of the intestine. When they eat anything containing wheat, rye, barley, or, for some people, oats, this rash damages the cells that line the intestine and causes problems ranging from bloating and abdominal pain to severe diarrhea and wasting illness.
What causes celiac disease?
Celiac disease occurs when a person’s immune system reacts to proteins—what we call gluten—present in wheat, rye, barley, and, for some people, oats. The immune system acts as if the cereal grains are dangerous pathogens and tries to rid the body of them. In performing this attack, the immune system damages the tissues that make up the intestine.
Is someone born with celiac disease? Is it genetic?
People are not born with celiac disease, but it does have a very strong genetic component. It tends to run in families. What happens is normal variance of certain genes that help control the immune response are required for a person to develop celiac disease. But most people with those gene variations actually don’t develop celiac disease. There’s no genetic test that will help diagnose celiac disease, but we’re investigating closely to see what genes are involved in contributing risk for celiac disease.
What are the classic and typical symptoms of celiac disease?
The classic symptoms of celiac disease are profound diarrhea and wasting illness; however, the classic symptoms are really quite rare. Most people don’t have that. The typical symptoms of celiac disease are bloating, abdominal pain, irritable bowel-type symptoms, and fatigue. Some of the signs, or some of the problems that people have if they have celiac disease, are unexplained anemia, thinning of the bone (something that we call osteomalacia), and a mild irritation of the liver. Another one of the classic symptoms of celiac disease is something called dermatitis herpetiformis, which is a skin rash that’s intensely itchy and develops in some people with celiac disease.
If celiac disease is not diagnosed, what long-term conditions can develop?
There’s a whole spectrum of illnesses that can develop. Most of the illnesses occur due to longstanding, low-grade malabsorption of key nutrients. So for example, anemia develops because a person doesn’t absorb enough iron; bones get thin because they don’t absorb enough vitamin D and calcium. If it’s untreated for long periods of time, one of the main concerns that we have is that a person can actually cause permanent damage to the lining of the intestine and develop what we call refractory sprue. That is when even when you remove gluten, then they don’t bounce back and it can proceed, causing intestinal lymphoma or cancer of the immune system that normally polices that intestine.
If someone experiences these symptoms, how is celiac disease diagnosed?
If a person wants to be tested for celiac disease, they can start off with a very simple blood test that looks for an antibody called anti-tissue transglutaminase, which develops in some people with celiac disease. Most people with celiac disease will have an antibody against tissue transglutaminase, so they can do a screening test for that. If a person has that antibody, then we would normally go ahead and do a biopsy of their small bowel to confirm that they have celiac disease. There are rare people who don’t develop that antibody, so on occasion we’ll go down and do a biopsy of the small bowel to make sure that a person doesn’t have celiac disease even if they’re antibody negative.
How is celiac disease treated?
The main treatment is strict avoidance of any food that contains gluten: so avoidance of any food that contains wheat, rye, barley, and, for some people, oats. To help people avoid those foods, we give them dietary training—they meet with nutritionists. There are new food laws out now so that most food products are labeled if they contain wheat, rye, or barley gluten, and that’s getting better and better over time. Now that we know celiac disease is fairly common, manufacturers are making many more gluten-free products, so the diet is no longer as restrictive as it used to be.
Does treatment involve medication or is it strictly diet?
We try to treat a person with diet alone as much as possible because that really helps resolve any of the problems. On occasion, we’ll have to treat a person with medications to help combat the symptoms, for example, or help them rebuild bone. But we try very hard to treat them with diet alone.
Can celiac disease be cured?
It depends on what you mean by cure. If a person has celiac disease, they don’t outgrow it; there’s no way to really cure them of it easily. But if a person’s on a strict gluten-free diet, after they’ve been on it for a couple years, they’re perfectly normal and we can’t even tell medically that they have celiac disease. They have normal life spans, normal everything as long as they maintain a gluten-free diet. From UI Health Care
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