What is Celiac Disease?
Celiac disease is a permanent intolerance to the gliadin fraction of wheat
protein and related alcohol-soluble proteins (called prolamines) found in
rye and barley. Celiac disease occurs in genetically susceptible
individuals who eat these proteins, leading to an autoimmune disease, where
the body’s immune system starts attacking normal tissue. This condition
continues as long as these food products are in the diet.
The resulting inflammation and atrophy of the intestinal villi (small,
finger-like projections in the small intestine) results in the
malabsorption of critical vitamins, minerals, and calories. Signs and
symptoms of celiac disease classically include diarrhea, short stature,
iron-deficiency anemia and lactose intolerance. However, many patients will
also present with “non-classical” symptoms of celiac disease, such as
abdominal pain, “irritable bowel”, and osteoporosis. Patients may also be
screened for celiac disease because of the presence of another autoimmune
disease, such as type I diabetes or thyroid disease, or a family
history of celiac disease, without having any obvious symptoms. Serum antibodies can be
utilized to screen for celiac disease. However, the key to confirming the
diagnosis remains a small intestinal biopsy, and the patient’s subsequent
clinical response to a gluten free diet.
How is celiac disease different from gluten intolerance?
People can also experience ‘intolerance’ to gluten. Food intolerances are
not thought to be immune-related. GI symptoms with wheat or gluten
intolerance may include gassiness, abdominal pain, abdominal distension,
and diarrhea. These symptoms are usually transient, and do not cause the
permanent damage associated with celiac disease.
Why is it important to know if you have celiac disease, wheat allergy or
gluten intolerance?
Celiac disease, wheat allergy and gluten-intolerance are treated similarly,
in that patients with these conditions must remove wheat from their diet.
It is important to note, however, that there is a difference between these
three medical problems. Celiac disease is an autoimmune condition, where
the body’s immune system starts attacking normal tissue, such as intestinal
tissue, in response to eating gluten. Because of this, people with celiac
disease are at risk for malabsorption of food, which cause nutritional
deficiencies and may result in conditions such as iron deficiency anemia,
osteopenia, and osteoporosis. Persons with a wheat allergy or
gluten-intolerance usually do not have severe intestinal damage, and
therefore are not at risk for these nutritional deficiencies. They also
are not at increased risk of developing other autoimmune conditions. Unlike
a food allergy or food intolerance, celiac disease is an inherited
condition. This means family members may have it, too.
For this reason, if someone in your family is diagnosed with celiac disease, it is
recommended that first degree relatives (parents, children, siblings) are
screened as well. Finally, celiac disease involves the activation of a
particular type of white blood cell, the T lymphocyte, as well as other
parts of the immune system, which may increase the risk of developing GI
cancers, in particular lymphomas, in persons with celiac disease. Since
food allergies and intolerances do not involve this particular immune
system pathway, these patients are not at increased risk for these
cancers. While celiac disease, wheat allergy, and gluten-intolerance may be treated with
similar diets, they are not the same conditions.
Due to the genetic component, and risk of nutritional deficiencies, other autoimmune diseases,
and GI cancers, it is very important for a person to be properly diagnosed. If
you think you have celiac disease, going gluten-free may make you feel
better even before a diagnosis is confirmed. Now it’s easy to go gluten
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Source: American Celiac Disease Alliance
