Celiac Disease

Celiac Disease

Alternate Names

  • celiac sprue
  • nontropical sprue
  • sprue
  • gluten-sensitive enteropathy
  • gluten intolerance

Definition

Celiac disease is a malabsorption syndrome. The intestine is not able to absorb vital dietary nutrients from foods, because of an immune reaction to gluten, a component in many foods.

What is going on in the body?

Nutritional considerations are important for persons with celiac disease. People with celiac disease are sensitive to a cereal protein called gluten. This protein is found in rye, oats, and barley, but people with celiac disease are most sensitive to the type of gluten found in wheat. The protein causes a reaction in the person's small intestine that prevents absorption of essential nutrients from the diet. The defect in absorption leads to the symptoms of the disease and to malnutrition.

Risks

What are the causes and risks of the disease?

Celiac disease is not contagious. It has a genetic component, but the way it is inherited is not clear. Genetic counseling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with celiac disease is 5-10%.

Prevention

What can be done to prevent the disease?

There is no known way to prevent celiac disease. Genetic testing may be useful in some cases.

Diagnosed

How is the disease diagnosed?

Celiac disease may be diagnosed by observing the symptoms after an infant begins eating cereals. It is often diagnosed during the second year of life, though it can manifest later..A blood test may show impaired levels of carbohydrate absorption, or elevated levels of antibodies against certain body proteins.
Stool may be examined for excessive amounts of fat as this is a common sign of celiac disease. A healthcare provider may also order a barium enema x-ray study of the small bowel to check for increased intestinal secretion and clumping of the barium in the bowel.
When celiac disease is suspected, a biopsy of the small intestine may show an abnormal inner surface of the small intestine.

Long Term Effects

What are the long-term effects of the disease?

The long-term effects of celiac disease include:
  • anemia, which is a reduction in the number of red blood cells circulating in the blood
  • delayed growth
  • bone loss. Bone loss can cause osteomalacia in adults, with bone pain and tenderness. Bone loss in children is seen as rickets, with bowlegs, a protruding stomach and a pigeon breast in children.
  • defects of the nervous system
  • inflammation of the skin
  • malignant lymphoma

Other Risks

What are the risks to others?

Celiac disease is not contagious. It is an inherited disease, but the way it is inherited is not clear. Genetic counseling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with celiac disease is 5-10%.

Treatments

What are the treatments for the disease?

Many of the effects of celiac disease can be minimized with a special diet. People with celiac disease learn to avoid the proteins in cereal. The proteins in wheat, rye, barley, and oats cause the symptoms of the disease.
Some people may be able to tolerate oats, but oat products are frequently contaminated with wheat and thus cause symptoms. Oats should not be tested until initial recovery has occurred. Some people need therapy with steroid medications because dietary limitations are not enough to eliminate the symptoms.

Side Effects

What are the side effects of the treatments?

Use of steroids may cause memory loss, bone loss, weight gain, congestive heart disease, or high blood pressure.

After Treatment

What happens after treatment for the disease?

Dietary restriction or drug therapy will be needed throughout the person's life.

Monitor

How is the disease monitored?

Celiac disease is monitored by simple observation of symptoms.

Sources

King RA, Rotter JL and Motulsky AG: The Genetic Basis of Common Diseases. Oxford University Press, 1992.

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