Celiac Disease

What is celiac disease?
Celiac Disease or gluten enteropathy, is a chronic disease of the small intestine caused by the toxic effects of gluten, a protein found in wheat, barley, rye and oats, in genetically predisposed people. To those people, gluten triggers immune mechanisms which will ultimately result in the damage (atrophy) of the small intestine’s mucosa, therefore affecting the proper absorption of nutrients, vitamins and minerals. Therefore celiac disease is considered an autoimmune disease.
How common is it?
Celiac disease is more common nowadays than in the past. It is estimated that in Europe and the US it affects one in 100-200 people. However, the majority of people who have the condition remain undiagnosed. Celiac disease is more common among first degree relatives of patients (10%) as well as in individuals with other autoimmune diseases such as Type 1 Diabetes, autoimmune thyroiditis, psoriasis, dermatitis herpetiformis, autoimmune hypatitis and finally in people suffering from various syndromes such as Down’s syndrome, Turner’s syndrome, William’s syndrome.
What are the symptoms
New research shows that you can develop celiac disease at any age; from early childhood, if gluten has been included in an infant’s diet, to the age of 60 and above. The symptoms at the infancy up to the age of 2 include diarrhea, vomiting, anorexia and less frequently constipation, weight stagnation, bloating, indolence or irritability and malnutrition.

At an older age up to adolescence the symptoms include diarrhea or constipation, anorexia, weight stagnation or weight loss, iron-deficiency anemia fatigue, delayed growth and puberty, short stature, dental enamel defects of the permanent teeth, osteoporosis or osteopenia.

The signs and symptoms of celiac disease can vary greatly and are different in children and adults and this why there is sometimes a delay in the diagnosis of them. The most common signs for adults are symptoms that are related to the digestive system like irritable bowel system, anemia usually resulting from iron deficiency, elevated liver transaminase levels, osteoporosis, dermatitis herpetiformis (itchy skin rash), mood disorders (depression), missed menstrual periods, infertility.

Screening and diagnosis
There are several serologic (blood) tests available that screen for celiac disease antibodies, but initially patients are tested for celiac disease antibodies against tissue transglutaminase (tTG-ab) and endomysium. These antibodies can be assessed if the patient’s tTG-IgA test is normal. For these tests to work, you must be consuming gluten. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine, which is then analyzed to see if there is any damage consistent with celiac disease.
What is the treatment?
Once diagnosed, celiac disease is treated by following a lifetime strict gluten-free diet that is avoiding foods that contain wheat, barley, rye and oats. Indicative prohibited products are foods containing flour (bread, rusks, pies, pizzas, biscuits, pastries, cakes, etc.), pasta, deli meat, canned food, mayonnaise, mustard, sauces, creamy cheese, some beverages, beer, etc.

There is a wide variety of naturally gluten-free products such as meat, poultry, game and fish, milk and its products (yoghurt, feta cheese, cheese), all fresh vegetables, legumes, rice, corn, fruit, oil. These foods contain valuable nutrients for the diet of celiac disease sufferers as long as the preparation is done at home. When the food is ready-made or processed, the possibility that gluten is included in the processing is very big. For this reason special attention should always be paid when consuming those foods. Moreover it is not safe to consume food stuff where it is indicated that wheat is not contained because they may contain gluten from other grains like barley, rye and oats. Also, some medicine may contain gluten as an excipient.

Indicating on the label that the product is gluten-free, is the only way to ensure the patient.

What to expect after a gluten-free diet
After 15 days of adherence to a gluten-free diet, there is a dramatic improvement of symptoms and especially an increase in body weight and height (if the disease is diagnosed before adolescence). Doctors will use blood tests to monitor your response. The results of these tests, which are primarily designed as a way to detect celiac disease, usually become negative once you have been gluten-free for 6 to 12 months. In a period between 1-2 years the gluten-free diet heals the villous atrophy in the small intestine, causing symptoms to resolve.

Celiac disease is a chronic autoimmune disease, which means that you cannot “grow out” of it. The treatment for celiac disease is lifelong adherence to a strict gluten-free diet. There are many food items that may contain gluten, often in hidden or unexpected ways. Even eating a small quantity of gluten, has long-term implications on the patient’s health like a risk for iron deficiency, growth stagnation, infertility and malignancies. A strict gluten-free diet reduces these risks.

Follow-up care
After diagnosis and the beginning of a gluten-free diet, a check-up of the celiac disease antibodies against tissue transglutaminase (tTG-ab) is recommended until they are rated as normal. Patients should see their physician 3-6 months after their initial diagnosis and annually thereafter to identify nutritional deficiencies, address symptoms someone may still be experiencing, and confirm their adherence to the gluten-free diet. Moreover one’s ferritin levels should be checked at least once a year.
Family members screening
If a child or an adult has been diagnosed with celiac disease, the biological relatives should be tested for it as well (parents, siblings, children) since blood relatives have a risk (10%) of developing it too, even if there are no symptoms.