Celiac disease - sprue

Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.

Unfortunately, the exact cause of celiac disease is unknown. While we do not know what causes it, we do know what it does.  The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi.

This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

The disease can develop at any point in life, from infancy to late adulthood.  Another point of interest is that people who have a family member with celiac disease are at greater risk for developing the disease. It is most common in Caucasians and women are affected more often than men.  Studies put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.

The symptoms of celiac disease can be different from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools.  Other symptoms may include:

• Abdominal pain, bloating, gas, or indigestion
• Constipation
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, either constant or off and on
• Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
• Nausea and vomiting
• Stools that float, are foul smelling, bloody, or “fatty”
• Unexplained weight loss (although people can be overweight or of normal weight)

Due to the body's inablity to absorb necessary vitamins and  minerals many accompanying health complications may affect a person suffering from celiac disease.  Some of these complications may include depression, fatigue, bruising, hair loss, growth delay, nose bleeds, and muscle cramping.
Children with celiac disease may have:

• Defects in the tooth enamel and changes in tooth color
• Delayed puberty
• Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting
• Irritable and fussy behavior
• Poor weight gain
• Slowed growth and shorter than normal height for their age

Blood tests can detect several special antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will order these antibody tests if celiac disease is suspected.

If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.

Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.
A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment, which confirms the diagnosis. However, this does not mean that the disease has been cured.

However, if you believe that you may have celiac disease, removing all gluten from your diet will lead to a reversal of your symptoms and an easy diagnosis.

The only treatment for both celiac disease and gluten intolerance and involves removing all sources of gluten from the diet. This means that a person with a gluten allergy should not eat bread products, pastas, or processed food of any kind that contains wheat, rye, or barley in any form.

Link to Gluten-Free Diet
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003095/

Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3 - 6 months in children, but it may take 2 - 3 years in adults.
Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is made.
Some problems caused by celiac disease may not improve, such as a shorter than expected height and damage to the teeth.

You must carefully continue to follow the gluten-free diet. When untreated, the disease can cause life-threatening complications.  Delaying diagnosis or not following the diet puts you at risk for related conditions such as:

• Autoimmune disorders
• Bone disease
• Certain types of intestinal cancer
• Low blood count
• Low blood sugar
• Infertility or repeated miscarriage
• Liver disease

Because the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life.