Celiac Disease (Gluten Enteropathy) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- Celiac disease facts
- What causes celiac disease?
- What are the signs and symptoms of celiac disease?
- Are there other diseases or conditions associated with celiac disease?
- How is celiac disease diagnosed?
- What is the treatment for celiac disease?
- What are the complications of celiac disease?
- What is a gluten-free diet?
- Celiac Disease Pictures Slideshow
- Celiac Disease Quiz
- Gluten-Free Diet Pictures Slideshow
- Celiac Disease (Celiac Sprue) FAQs
- Find a local Gastroenterologist in your town
What are the signs and symptoms of celiac disease?
Diarrhea and weight loss because of malabsorption are the classic symptoms of celiac disease, but they occur in less than one-half of people with the disease. The symptoms vary widely in presentation and intensity. Often the symptoms are not related to the bowel function, but instead are due to the consequences of chronic malabsorption of vitamins and minerals (for example, people who complain of weakness, fatigue, and are anemic because they cannot absorb iron in the diet).
Other symptoms may include the following:
- Fatigue and weakness
- Joint pain
- Numbness and tingling (paresthesia) of the hands and feet
- Osteoporosis due to decreased absorption of calcium and vitamin D
- Skin rash
- Abdominal pain
- GERD and heartburn
Infants and children may have even less specific symptoms including diarrhea, constipation, weight loss, failure to thrive, and developmental delays.
Are there other diseases or conditions associated with celiac disease?
Celiac disease is thought to be an autoimmune disorder, meaning that the body develops antibodies against its own tissues. Researchers believe that other such diseases may be related, and may affect organs such as the thyroid (autoimmune thyroiditis), the liver (primary biliary cirrhosis), and colon (microscopic colitis). Other diseases may include type 1 diabetes and dermatitis herpatiformis, a skin rash that has similar antibodies as celiac disease, but that are found in the skin.
How is celiac disease diagnosed?
The diagnosis of celiac disease is often delayed and it may take several months or years for the patient and the health care professional to think of it as the cause of many non-specific symptoms. History and physical examination may give direction as to the diagnosis, but commonly it take many visits with the patient complaining of recurrent abdominal pain, non-specific joint aches, or demonstrating chronic anemia that does not respond to iron treatment, to raise the suspicion that celiac disease is a possibility.
When the diagnosis is suspected, there is a two-step screening process to make the diagnosis:
- Blood test for immunoglobulin A anti-tissue transglutaminase antibody (IgA TTG). Testing for antiendomysial antibody may also be considered.
- If the screening blood test is positive, then endoscopy and biopsy of the lining of the duodenum (the first part of the small intestine) is recommended. Usually performed under sedation, a fiberoptic tube is passed through the mouth, through the esophagus and stomach into the duodenum and a small bit of tissue is taken to be examined under a microscope.
It is important that the patient eats a regular diet for many weeks before the testing procedures. If the patient has already started a gluten free diet, it may cause the tests to be falsely negative.
Once the diagnosis is made, screening for osteoporosis may be appropriate.
Since it is often familial, once one person in the family is diagnosed with celiac disease, it is reasonable to have other close family members screened.
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