Celiac disease

David Elliott, MD, PhD, addresses the question, “What’s the big deal about celiac disease?”

David Elliot, MD, PhD
David Elliot, MD, PhD, is an internal medicine physician/researcher who specializes in gastroenterology.

When people with celiac disease eat foods made from these wheat, barley, rye, and sometimes oats, they develop rash-like inflammations that injure their intestines. Imagine a healthy small intestine where the villi—little finger-like projections that soak up nutrients—stand upright like a shag carpet. In celiac patients, the villi lie flat like a tile floor. This condition significantly reduces the patient’s ability to digest and absorb nutrients needed for good health.

Like other autoimmune diseases, celiac disease is being recognized more often. Yet most people with celiac disease are unaware they have it. This is because many of the condition’s symptoms are nonspecific.

Symptoms can include fatigue, bloating, abdominal pain, nausea after eating, loose stools, and weight loss. Not everyone has all or even any of these symptoms. In patients who are symptom-free, celiac disease is typically discovered during testing for unexplained anemia or thin bones caused by poor absorption of iron and calcium. Celiac disease also can cause liver problems, infertility, and a specific itchy rash called dermatitis herpetiformis.

If celiac disease is suspected, doctors can screen for the disorder with simple blood tests that look for antibodies associated with celiac disease. Most celiac patients have these antibodies, although people without celiac disease can have the antibodies and people with celiac disease can lack them.

The definitive test for celiac disease is an upper endoscopy and small bowel biopsy.

Treatment requires a gluten-free diet, which means total avoidance of foods containing the protein gluten, which is found in wheat, rye, barley, and sometimes oats. Because these grains are used in many foods—sometimes in trace amounts not listed among the ingredients–gluten-free diets can be quite restrictive.

Now that celiac disease is more commonly recognized, however, many companies have started making gluten-free products. Indeed, gluten-free eating can be quite enjoyable. For example, see three gluten-free “Good Health Recipes”:

Green bean salad

Avacado smoothie

Spiced basmati rice

Adhering to a gluten-free diet is vital for celiac patients. When adhering strictly to the diet, the patient’s intestine heals and blood tests normalize. Eventually, as long as the diet remains gluten-free, we cannot even tell if the person has celiac disease. However, reverting to a regular diet assures that the inflammation and blood test abnormalities will return.

The stakes are high. Long-term inflammation can permanently damage the intestines.  Untreated celiac disease can cause cancer of the immune system. In our University of Iowa clinics, we teach patients how to avoid foods that contain gluten and we occasionally test them to make sure they are not being exposed to gluten without their knowledge.

Some people are at higher risk. For example, people with autoimmune or Type 1 diabetes have a ten-fold higher risk of developing celiac disease. Celiac disease also tends to run in families. People with close family members that have celiac disease are more likely to develop the illness. Therefore, we often screen certain people for celiac disease even if they have minimal or no symptoms.

Gluten-free diets have become popular among many people who do not have celiac disease because it makes them feel better. This is fine as long as the diet is well-balanced. However, these people can eat gluten-containing foods if they wish. Patients with celiac disease have no such luxury. They must refrain from eating any foods with gluten. Therefore, anyone who thinks gluten is causing them problems should be tested to see if celiac disease is the cause.

For more information or to schedule a test in the UI Celiac Disease Clinic, call 319-356-8390 or 800-777-8442 and ask for the Digestive Disease Clinic. Children with celiac disease are seen at UI Children’s Hospital, 319-356-2229.

–Spring/Summer 2013