CELIAC DISEASE
Celiac disease is caused by an allergic reaction to proteins (gluten) contained in wheat, rye, oats and barley. The lining of the small intestine becomes inflamed and shrinks, which leads to inability to absorb nutrients. The disease has a strong genetic component. People of Celtic ancestry are especially prone to celiac disease. Celiac disease (also called gluten-sensitive enteropathy, celiac sprue) has a wide spectrum of clinical presentations. In the classic form, the bowel lining is damaged and classic signs of malabsorption occur. These include weight loss, foul smelling stools, diarrhea and various nutritional deficiency signs and symptoms. The atypical form is much more common than previously thought. Blood tests that measure the antibodies involved in the disease show that as many as 1 in 100 Americans may have these antibodies. Relatives of people who have the illness have a 1 in 22 chance of also having the antibodies.
The atypical form of illness may not have the classic signs of malabsorption. Instead the problem may show up as iron deficiency, osteoporosis, folate or Vitamin B 12 deficiency, short statue or infertility. In some people, the lining of the intestine is normal and the only abnormality is the presence of the antibodies. The antibodies tested can include IgA antigliadin antibodies, IgA anti-endomysial antibodies and anti-tissue transglutaminase antibodies. These tests have various levels of accuracy at diagnosing the illness. The endoscopic biopsy of the small intestinal lining, which shows characteristic changes under the microscope, is considered the most accurate test.
In some individuals, celiac disease can lead to cancers of the intestines or immune systems (lymphomas) and ulcerative colitis (bowel inflammation with bloody stools). It appears that the risk of developing these secondary complications of celiac disease can be eliminated by adhering to a diet free of gluten.
The only effective treatment in a fully developed case of celiac disease is total elimination of all gluten in the diet. This can be quite difficult since wheat (and the other grains that contain gluten) is frequently found in small quantities in processed and restaurant foods. It is not known if elimination of dietary gluten in people with antibodies in the blood but no sign of clinical disease will prevent the classic signs of the disease from occurring.
A complete medical update on celiac disease has recently been released by the Agency for Healthcare Research and Quality. The report is online at www.ahrq.gov/clinic/epcsums/celiacsum.
Daniel Blodgett MD