Celiac disease involves the body’s immune response to derivatives of gluten a protein in wheat, rye, and barley. The prevalence of celiac disease in the United States is approximately 1 in 100 (1%). The disease occurs because the patient has the genetic make-up to react to gluten proteins causing an inflammatory reaction in the small intestine. The chronic inflammation can impair digestion and absorption of key nutrients resulting in a spectrum of disease. A celiac patient has the genetic component at birth, but many are not symptomatic or start reacting to gluten until later in life. When a patient develops symptoms varies among patients and can develop as late as 70 or 80 years of age. It is hypothesized that a trigger, often infection, can precipitate the inflammatory reaction.
Iron deficiency anemia, recurrent abdominal pain, constipation, diarrhea, mood changes, infertility, vitamin D and calcium deficiency, and multiple neurologic complaints are all presenting signs and symptoms of celiac disease. Dermatitis herpetiformis (the characteristic skin lesion), elevated liver enzymes, thyroid disease, irritable bowel syndrome, and diabetes have all been associated with celiac disease.
The American Gastroenterology Association supports the serologic testing of symptomatic patients who are high risk with the above aformentioned complaints or physical manifestations. The diagnostic test of choice with the highest yield given the specificity of 95% and sensitivity of 90-96% is Immunoglobulin A tissue transglutaminase (TTG). Given patients with celiac disease have immunoglobulin A deficiency, IgA level should be checked as well. If serologic testing returns positive gold standard for diagnosis includes small bowel biopsy obtained during esophagogastroduodenoscopy. It is very important that the patient must be on a gluten containing diet prior to the procedure to note if the inflammatory reaction is occurring.
Celiac disease requires a strict lifelong adherence to a gluten free diet. Gluten containing foods include: pastas, processed meats, breads, broth, marinades, and cereals just to name a few. Certain medications can contain gluten ingredients with gluten containing fillers in both prescription and over the counter medications. Dieticians with the expertise in gluten free diet and pharmacists often help to aid patients in making the appropriate lifestyle changes to ensure a gluten free diet. Treatment of nutritional deficiencies such as iron, B12, folate, and vitamin D are very important in preventing serious metabolic complications. Compliance to the gluten free diet is important in preventing small bowel lymphoma which is increased in patients with celiac disease.
For more information regarding celiac disease visit www.celiac.org or contact Dr. Echelmeyer at JCMG Gastroenterology.
