also known as gluten-sensitive enteropathy, is a chronic autoimmune disorder affecting the digestive system. It is triggered by exposure to gluten, a protein found in wheat, barley, rye, and some oat-based products such as bread, pasta, and biscuits.
When a person with celiac disease consumes gluten-containing foods, their immune system attacks the lining of the small intestine, causing inflammation and damage to the intestinal villi. These villi are essential for nutrient absorption, and their destruction leads to malabsorption of vital nutrients, affecting the brain, nervous system, bones, liver, and other critical organs. This deficiency can impair organ function and increase the risk of various diseases.
Symptoms of Celiac Disease
1. Common Symptoms
Some individuals with celiac disease may not experience symptoms, while others may develop symptoms similar to those of other conditions such as irritable bowel syndrome (IBS), anemia, parasitic infections, skin disorders, or neurological disorders.
Possible symptoms include:
- Diarrhea
- Abdominal pain
- Bloating
- Irritability and depression
- Anemia
- Gastrointestinal discomfort
- Joint pain
- Muscle cramps
- Skin rash
- Mouth ulcers
- Dental or bone problems
- Numbness in the legs due to neuropathy
- Unintentional weight loss
- Fatigue and weakness
- Pale, foul-smelling, fatty stools
- Delayed growth in children
- Osteoporosis
2. When to See a Doctor
Immediate medical consultation is recommended in the following cases:
If any symptoms of celiac disease appear
If a family member has celiac disease
If an individual experiences:
Pale skin
Discomfort and unease
Growth delay
Abdominal distension
It is crucial to consult a doctor before switching to a gluten-free diet, as other conditions may cause similar symptoms.
Causes and Risk Factors of Celiac Disease
1. Role of Intestinal Villi
The small intestine is lined with tiny, hair-like projections called villi, which absorb essential vitamins, minerals, and nutrients from food.
When these villi are damaged, the intestinal lining becomes smooth, reducing the body's ability to absorb essential nutrients. As a result, vital substances like fats, proteins, vitamins, and minerals pass through the digestive system unabsorbed, leading to nutritional deficiencies.
2. Causes of Celiac Disease
The exact cause of celiac disease remains unclear, but certain factors increase the likelihood of developing the condition:
A. Genetic Factors
Celiac disease has a strong genetic component, with a 5% to 15% risk of developing the disease if a close relative is affected.
B. Environmental Triggers
In some cases, celiac disease appears after a physical or emotional stressor, such as:
- Infections
- Physical trauma
- Pregnancy-related stress
- Severe emotional stress
- Surgical procedures
C. Associated Medical Conditions
Individuals with certain diseases are at a higher risk of developing celiac disease, including:
Type 1 diabetes
Thyroid disorders
Microscopic colitis
D. Genetic Markers
Specific genetic markers, such as HLA-DQ2 and HLA-DQ8, are linked to an increased risk of celiac disease. Other unidentified genetic factors may also contribute to the disease.
Complications of Celiac Disease
Without proper management, celiac disease can lead to several complications:
1. Malnutrition
Malabsorption occurs despite a healthy diet, leading to deficiencies in:
Vitamin B12, Vitamin D, folic acid, and iron, resulting in anemia and weight loss.
2. Reduced Bone Density
Chronic fat malabsorption leads to deficiencies in calcium and vitamin D, which are essential for bone health. This can cause:
Osteopenia (low bone density)
Osteoporosis (brittle bones prone to fractures)
Kidney stones due to improper calcium absorption
3. Lactose Intolerance
Damage to the intestinal lining may impair the digestion of lactose, the sugar found in dairy products. Symptoms include:
Abdominal pain
Diarrhea
Some individuals may tolerate dairy again after intestinal healing, while others may develop permanent lactose intolerance.
4. Increased Cancer Risk
Untreated celiac disease is linked to a higher risk of gastrointestinal cancers, such as:
Intestinal lymphoma
Gastrointestinal malignancies
5. Neurological Disorders
Celiac disease has been associated with neurological complications, including:
Epileptic seizures
Peripheral neuropathy (nerve damage affecting sensation and movement)
Diagnosis of Celiac Disease
Diagnosing celiac disease is challenging because its symptoms resemble those of many other conditions. However, specialized blood tests can aid in detection, even in asymptomatic individuals.
Key diagnostic findings:
Elevated levels of anti-gluten antibodies
Elevated anti-endomysial and anti-tissue transglutaminase antibodies
Confirmatory Tests
A definitive diagnosis requires a small intestine biopsy, which involves:
Inserting a thin, flexible tube (endoscope) through the mouth into the stomach and small intestine.
Taking a tissue sample to examine for villous atrophy.
Treatment of Celiac Disease
There is no cure for celiac disease, but strict adherence to a gluten-free diet is essential for managing symptoms.
Symptoms improve within days to weeks after starting a gluten-free diet.
Severe nutritional deficiencies may require supplementation as advised by a physician or dietitian.
Young patients may recover fully within weeks, while older individuals may require up to 2-3 years for complete intestinal healing.
Foods to Avoid
Individuals with celiac disease must avoid foods containing gluten, including:
- Semolina
- Wheat
- Barley
- Oats
- Bulgur
- Buckwheat
- Accidental Gluten Exposure
If a person with celiac disease accidentally consumes gluten, they may experience abdominal pain and diarrhea. However, some individuals may not show immediate symptoms, but intestinal damage still occurs.
Most patients recover fully with strict dietary adherence, but in rare cases, severe intestinal damage may persist despite dietary modifications. If a gluten-free diet fails to control symptoms, medications may be prescribed to reduce intestinal inflammation and improve nutrient absorption.
Prevention of Celiac Disease
There are no definitive prevention methods for celiac disease, as its exact cause remains unknown. However, early diagnosis and a strict gluten-free diet can help prevent complications and improve the quality of life for those affected.