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Celiac Disease  


 

Symptoms - CD 
Symtoms - DH 

 

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National Foundation for Celia Awareness is offering a 1.5 credit CME course for health-care professionals on Celiac Disease. Click here to get more info.

To learn more about the recently published multi-center prevalence study of celiac disease visit, www.celiaccenter.org.

Symptoms
Celiac disease was once thought of a disease with only GI symptoms. It is now recognized that the disease is a multi-symptom, multi-system (organ) disease. Celiac disease also does not routinely present with the 'textbook' symptoms that physicians learn. More often it presents with symptoms that can mimic other problems.

Most physicians recognize the classic symptoms of celiac disease : diarrhea, bloating, weight loss, anemia, chronic fatigue, weakness, bone pain, and muscle cramps. Physicians may not be aware that celiac disease frequently presents with other symptoms, some that do not involve the small intestine. More often, symptoms can include constipation, constipation alternating with diarrhea, or premature osteoporosis. Overweight persons may also have undiagnosed celiac disease. Children may exhibit behavioral, learning or concentration problems, irritability, diarrhea, bloated abdomen, growth failure, dental enamel defects, or projectile vomiting. Others will have symptoms such as rheumatoid conditions, chronic anemia, chronic fatigue, weakness, migraine headaches, nerve problems such as tingling of hands or difficulty walking, or other conditions that are unexplained and/or do not respond to usual treatment. People may have one or more of the above symptoms or none of them. Patients are frequently misdiagnosed as having 'irritable bowel syndrome', 'spastic colon/bowel', or Crohn's disease'. This description is provided by GIG.

Diagnosis
Serological -
Initial screening for CD is normally a blood test taken by your physician. The test can be referred to as a Celiac Panel or by the names of the individual tests. To provide the most accurate information,the blood test should include the following tests: anti-endomysial antibody (lgA EMA) and anti-gliadin antibody (lgA & IgG), and tissue transglutaminase (tTG IgA). These tests are very sensitive and specific for celiac disease.

Genetic - A non-invasive genetic test can be taken which will show if you have the genetic pattern normallyseen in patients with CD/DH - it is believed that this pattern must be present for an individual to have GSE, CD and/or DH. Individuals with GSE and continuing to consume gluten may be at risk to develop CD/DH.

Biopsy - As a final test, your physician may refer you to a gastroenterologist who will perform an endoscopy. In this procedure, a series of samples or tissue biopsies are taken from your small intestine. They will be reviewed by a lab under a microsope to look for damage villi. Traditionally,  a biopsy showing damaged villi in the small intestine is the first half of the 'Gold Standard' to diagnosing CD. Some physicians are beginning to accept a positivie result from the blood test alone and consequent improvement on the GF diet as a solid diagnosis.

It is possible, in some situations, to have "normal" blood tests and/or biopsy via endoscopy and still have celiac disease.  

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Treatment
Strict adherence to a gluten-free diet for life is the only treatment currently available. This involves the elimination of wheat, rye, barley, and derivatives of these grains from your diet. Medication is not normally required, unless there is an accompanying condition, e.g. osteoporosis, dermatitis herpetiformis, etc. Thriving, showing improvement and return of health on the gluten-free diet is the second half of the 'gold standard' of being diagnosed with CD.

Questions to Ask Your Doctor:

  • Should I take nutritional supplements?
  • Could I have associated food intolerances?
  • Where can I have a bone density study?
  • What other concerns should I have?
  • How can I find out about the diet?

Prognosis
Excellent, if you stay on the gluten-free diet. The small intestine will steadily heal and start absorbing the needed nutrients. You should start feeling better almost immediately; however, complete recovery may take several months to years. 

Related Disorders
Dermatitis herpetiformis is also present in some people with celiac disease. Other autoimmune disorders that people with CD are at greater risk to develop include Addison' s disease, autoimmune chronic active hepatitis, Alopecia Areata, Graves' disease, insulin-dependent diabetes mellitus (type 1), myasthenia gravis, scleroderma, Sjogren's syndrome, lupus, and thyroid disease. Thyroid diseases and diabetes are the two most commonly associated diseases found with celiac disease. Thyroid disease is most commonly associated with DH.

Other conditions frequently seen in persons with gluten intolerance include anemia, early bone disease, Downs Syndrome, and fertility problems. Some persons with DH also have a higher incidence of other skin conditions, such as eczema.

While other connections have been suggested - such as with autism, MS, and mycosis fungoides, the research is either inconclusive, suggests a weak connection or offers no substantial connection.

As knowledge of gluten intolerance diseases expands and new findings become available, you can expect that the list of associated health problems and conditions will also change. 

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