Understanding Celiac Disease
Celiac disease is a systemic disorder in which the body can't tolerate gluten. The gluten triggers an immune reaction and causes inflammation of the lining of the small intestine, which can eventually interfere with the absorption of nutrients from food.
The problem can be difficult to diagnose because the symptoms are varied and similar to those of many other intestinal conditions, including irritable bowel syndrome (IBS) and lactose intolerance. Some people have no apparent symptoms or their symptoms are so subtle that they never mention them to their doctor. As a result, celiac disease may be misdiagnosed or go undiagnosed for years.
Celiac disease was once considered a relatively rare condition, but it's estimated to affect almost 1% of the U.S. population (one in 133 people). Moreover, it has long been speculated that those with diagnosed celiac disease represent the tip of a "celiac iceberg" — a much larger number of people with asymptomatic celiac disease who nonetheless are incurring intestinal damage or who have hidden nutritional deficiencies, such as iron deficiency with anemia .
Celiac disease can develop at any time in life. The average age at diagnosis in the United States is 46; about 20% of cases are diagnosed after age 60. A tendency to develop celiac disease is inherited. Thus, parents, siblings, and children of people with celiac disease have a 5% to 15% chance of developing the disease. Not only are people with a family history of the condition at greater risk of developing it, but so are specific populations. Celiac disease is common among people of northern European descent but less frequent among African Americans, Asians, and Native Americans.
Symptoms and signs of celiac disease
. Gas
. Bloating
. Abdominal cramps
. Diarrhea
. Foul-smelling stools
. Fatigue
. Weight loss
. Canker sores
. Itchy blisters on elbows and knees
. Balance and gait problems
. Tooth discoloration
. Osteoporosis
. Iron deficiency with anemia
. Infertility
Setting the stage for celiac disease
People with celiac disease have an immune reaction that is triggered by gluten. The immune reaction causes inflammation in the lining of the small intestine, where it damages villi and microvilli that are essential for normal digestion (see Figure 5). When these tiny structures are damaged, the intestine cannot absorb nutrients properly, leading to malnourishment. Celiac disease is defined as an autoimmune condition because the body's own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also are more likely to develop other autoimmune diseases, such as thyroid disease and type 1 diabetes. A few conditions frequently coexist with celiac disease, including dermatitis herpetiformis (an itchy, blistering rash) and liver inflammation. For example, the rate of celiac disease in people with type 1 diabetes is four to 10 times the average. Infertility, recurrent miscarriages, and neurological problems such as ataxia (loss of coordination) have also been linked to this disease.
When people with celiac disease eat foods that contain gluten, gluten proteins permeate the wall of the small intestine and are taken up by immune cells called macrophages, which digest them and send a signal to other immune cells called T cells (1). In response, T cells emit chemicals called cytokines that trigger inflammation and also notify B cells, another group of immune cells, to produce antibodies to gluten (2).
As the immune system wages war against gluten, the intestinal villi and microvilli suffer collateral damage. The villi become eroded and flatten, which leaves the small intestine less capable of absorbing nutrients. The result is diarrhea and a host of health problems related to malnutrition, including weight loss, anemia, and osteoporosis.
The problem can be difficult to diagnose because the symptoms are varied and similar to those of many other intestinal conditions, including irritable bowel syndrome (IBS) and lactose intolerance. Some people have no apparent symptoms or their symptoms are so subtle that they never mention them to their doctor. As a result, celiac disease may be misdiagnosed or go undiagnosed for years.
Celiac disease was once considered a relatively rare condition, but it's estimated to affect almost 1% of the U.S. population (one in 133 people). Moreover, it has long been speculated that those with diagnosed celiac disease represent the tip of a "celiac iceberg" — a much larger number of people with asymptomatic celiac disease who nonetheless are incurring intestinal damage or who have hidden nutritional deficiencies, such as iron deficiency with anemia .
Celiac disease can develop at any time in life. The average age at diagnosis in the United States is 46; about 20% of cases are diagnosed after age 60. A tendency to develop celiac disease is inherited. Thus, parents, siblings, and children of people with celiac disease have a 5% to 15% chance of developing the disease. Not only are people with a family history of the condition at greater risk of developing it, but so are specific populations. Celiac disease is common among people of northern European descent but less frequent among African Americans, Asians, and Native Americans.
Symptoms and signs of celiac disease
. Gas
. Bloating
. Abdominal cramps
. Diarrhea
. Foul-smelling stools
. Fatigue
. Weight loss
. Canker sores
. Itchy blisters on elbows and knees
. Balance and gait problems
. Tooth discoloration
. Osteoporosis
. Iron deficiency with anemia
. Infertility
Setting the stage for celiac disease
People with celiac disease have an immune reaction that is triggered by gluten. The immune reaction causes inflammation in the lining of the small intestine, where it damages villi and microvilli that are essential for normal digestion (see Figure 5). When these tiny structures are damaged, the intestine cannot absorb nutrients properly, leading to malnourishment. Celiac disease is defined as an autoimmune condition because the body's own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also are more likely to develop other autoimmune diseases, such as thyroid disease and type 1 diabetes. A few conditions frequently coexist with celiac disease, including dermatitis herpetiformis (an itchy, blistering rash) and liver inflammation. For example, the rate of celiac disease in people with type 1 diabetes is four to 10 times the average. Infertility, recurrent miscarriages, and neurological problems such as ataxia (loss of coordination) have also been linked to this disease.
When people with celiac disease eat foods that contain gluten, gluten proteins permeate the wall of the small intestine and are taken up by immune cells called macrophages, which digest them and send a signal to other immune cells called T cells (1). In response, T cells emit chemicals called cytokines that trigger inflammation and also notify B cells, another group of immune cells, to produce antibodies to gluten (2).
As the immune system wages war against gluten, the intestinal villi and microvilli suffer collateral damage. The villi become eroded and flatten, which leaves the small intestine less capable of absorbing nutrients. The result is diarrhea and a host of health problems related to malnutrition, including weight loss, anemia, and osteoporosis.
- CNN
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