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Celiac disease is a disease characterized by an abnormal immune system reaction against gluten (a protein contained in wheat, rye, barley, and a multitude of prepared foods). The consequences of which cause damage to the lining of the small intestine. This was once thought to be an extremely rare disease but now in most recent studies in America it has been found to be 1 in 250 people. Celiac disease can occur in people of any age and affects both genders.
Most patients will have diarrhea and symptoms of malabsorption. However, due to the fact that often children now are breast feeding and gluten is not introduced until later in life, we are now seeing this disease between ages 10 to 40. Patients will have subclinical disease or mild disease with very mild symptoms. Some of the symptoms will be mostly gas and bloating and vague abdominal pain, which is chronic, and often felt to be secondary to stress or functional bowel disease and irritable bowel syndrome; however, they actually have celiac disease. There is also a very good association with type I diabetes, such that two to eight percent of type I diabetics have celiac disease. It is also a cause of iron deficiency anemia later in life. So, if you are a patient who has bloating, gas, diarrhea, or chronic iron deficiency anemia and they are not sure why, or if you have been labeled “irritable bowel syndrome” you may wish to be screened for celiac disease.
A screening blood test can be done in an office laboratory
These tests are positive in more than 90 percent of people with untreated celiac disease and rarely positive in those without celiac disease. Confirmation of the diagnosis requires an examination of a sample of the lining of the small intestine under a microscope done during an upper endoscopy. It is a very safe test and involves swallowing a small, flexible instrument that can allow your doctor to examine the upper part of the gastrointestinal system. A sample of the small intestine (biopsy) can be obtained during the examination. The biopsy is not painful.
Patients with celiac disease should tested for nutritional deficiency that may result from malabsorption, such as folic acid, B12 deficiency, and vitamin K deficiency. Often I will also often order a DEXA scan to test for bone loss, which is a painless imaging test that determines the density of bone. We often recommend vaccination against pneumonia (Pneumovax).
The corner stone of celiac disease is to completely eliminate gluten from the diet. Patients who are malnourished because of the disease may also need certain nutrient supplements. Patients who develop significant bone loss may require specific treatment.
Maintaining a gluten-free diet can be a difficult test requiring major lifestyle adjustments as gluten is contained in most commonly consumed grains in the Western world (wheat, rye, and barley) and is included as an additive in multiple prepared foods. Thus, it is usually best to consult with a nutritionist who can provide detailed guidance and written information on permissible food. Life on a gluten-free diet has become increasingly easier with gaining popularity of gluten-free foods. Excellent gluten-free substitutes for traditional gluten-containing foods are now widely available.
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You Should Know :Dr. Bhandari specializes in digestive disease disorders. He is triple board certified in Internal Medicine, Medical Nutrition & Gastroenterology. He is a highly trained and specialized endoscopist. |
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