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Celiac Disease

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Ismail Munir

Overview

Celiac disease is a common autoimmune disorder that affects the small intestine. The disease is also known as celiac sprue or gluten sensitive enteropathy as it is triggered by gluten, a protein usually found in flours. Altering the diet with gluten-free options is one way to keep the symptoms at bay<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

The all-new gluten-free diet hype created a lot of much-needed awareness not just for celiac disease but also for gluten sensitivity. The complex immune-mediated disorder affects multiple organs.

The disease is often compared with non-celiac gluten sensitivity. The difference between the two is that the body tends to damage the small intestine in Celiac disease, whereas non-celiac sensitivity is limited to symptoms like nausea, vomiting, headaches, diarrhea, fatigue, etc.

Celiac disease affects around 1% of the entire world population. There is no recorded data on Celiac disease in Pakistan, but the percentage is believed to be the same<a href="#accordion">[2]</a>.

<div>&nbsp;</div>

There are 3 types of celiac diseases<a href="#accordion">[3]</a>:

&nbsp;

<ul>
	<li>Classical Celiac Disease: A majority of individuals suffer from this form of celiac disease, which is easily diagnosed in the individual&rsquo;s early life. Individuals who experience malabsorption, frequent diarrhea, lack of appetite, sickness etc. are often suspected of having classical celiac disease</li>
</ul>

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<ul>
	<li>Non-Classical Celiac Disease: Individuals with this type of celiac disease tend to have mild stomach problems with no clear signs of malabsorption. It is common for them to suffer from bloating and pain and may experience <a href="https://www.merisehat.pk/disease/anemia" target="_blank">anemia</a>, fatigue, <a href="https://www.merisehat.pk/disease/migraines-73" target="_blank">migraine,</a>&nbsp;etc. Individuals with non-classical celiac disease also suffer from <a href="https://www.merisehat.pk/disease/depression" target="_blank">depression </a>and anxiety, and experience trouble losing weight.</li>
</ul>

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<ul>
	<li>Silent Celiac Disease: Also known as subclinical celiac disease, this type of celiac disease does not show severe symptoms in the patients. Only small disturbances are experienced in the small intestine, including bloating, flatulence and acid reflux.&nbsp;</li>
</ul>

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Signs And Symptoms

Depending on the type of celiac disease that the patient has, the symptoms and their severity varies. These include:

<ul>
	<li>Abdominal pain</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Loose and greasy stools</li>
	<li>Bloating</li>
	<li>Diarrhea</li>
	<li><a href="https://www.merisehat.pk/disease/constipation" target="_blank">Constipation</a></li>
	<li>Lactose intolerance</li>
</ul>

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In children, the symptoms differ due to their inability to absorb the nutrients. The symptoms include:

<ul>
	<li>Damaged teeth</li>
	<li>Delayed puberty</li>
	<li>Underweight with respect to the age</li>
	<li>Slowed growth</li>
</ul>

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In some cases of celiac disease, people experience:&nbsp;

<ul>
	<li>Fatigue</li>
	<li>Seizures</li>
	<li><a href="https://www.merisehat.pk/disease/depression" target="_blank">Depression </a>and <a href="https://www.merisehat.pk/disease/anxiety" target="_blank">anxiety</a>&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/infertility-in-men" target="_blank">Infertility&nbsp;</a></li>
	<li>Amenorrhea</li>
	<li>Canker sores&nbsp;</li>
</ul>

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Causes

Celiac disease has been linked to genes. There are other factors believed to be at play, but that aspect is still under extensive research. When it comes to genes, the presence of gene variants DQ2 and DQ8 are related to the development of celiac disease. Even though nearly 30% of the total population have those variants, only 3% of the people actually develop the disease; the disease is triggered once the individual consumes gluten<a href="#accordion">[4]</a>.

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Diagnosis

Diagnosis of celiac disease involves the examination of the symptoms which is followed by some tests including:

&nbsp;

<ul>
	<li>Serology Testing: Serology testing monitors the antibody production in the body. The test identifies if there are any certain types of antibody proteins in the blood. If the results show elevated levels, it&rsquo;s an indication of the presence of the disease.</li>
</ul>

&nbsp;

<ul>
	<li>Genetic Testing: This test looks for human leukocyte antigens, i.e., HLA-DQ2 and HLA-DQ8.</li>
</ul>

&nbsp;

<ul>
	<li>Endoscopy: A long tube with a tiny camera attached to it is used in this process. The tube is put into the mouth of the patient, allowing the practitioner to view the small intestine and take a tissue sample for further analysis.</li>
</ul>

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Capsule endoscopies are also performed in this case where a wireless camera is used to take pictures of the patient&rsquo;s small intestine.&nbsp;

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Treatment

There is no one-time cure for celiac disease or a treatment. The only way to keep the symptoms of celiac disease at bay is by completely avoiding gluten. Following such a diet reduces symptoms and, in some cases, it may even stop the disease from causing further damage. Consumption of gluten at any point, regardless of the age group, can cause long-lasting damage to the small intestine.&nbsp;

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Untreated or unmaintained celiac disease may cause several other complications, like:

<ul>
	<li>Lactose intolerance</li>
	<li>Vitamin and mineral deficiency, i.e., iron, calcium, fiber, magnesium, folate, niacin, vitamin D, and Vitamin B12</li>
	<li>Lowered calcium absorption that, in turn, leads to <a href="https://www.merisehat.pk/disease/osteoporosis-80" target="_blank">osteoporosis </a>and osteopenia</li>
	<li>Lymphoma&nbsp;</li>
	<li>Neuropathy</li>
	<li>Ataxia</li>
	<li><a href="https://www.merisehat.pk/disease/infertility-in-men" target="_blank">Infertility </a>and miscarriage</li>
</ul>

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Risk factors for the development of celiac disease include:

<ul>
	<li>Family history of celiac disease</li>
	<li>Type 1 diabetes</li>
	<li>Autoimmune thyroid disorder</li>
	<li>Addison&rsquo;s disease</li>
	<li>Lymphocytic or collagenous colitis</li>
	<li>Down syndrome</li>
	<li>Turner syndrome</li>
</ul>

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There is no exact way to prevent the development of the disease. The only theoretical way of stopping the disease from developing, especially in children, is to not feed them gluten in any way. Realistically speaking, this is a very difficult approach<a href="#accordion">[7]</a>.&nbsp;

However, one can always take certain measures for better at-home maintenance of the disease by consuming a gluten-free diet and avoiding foods containing wheat, rye, oats, and barley.&nbsp;

Since many people with celiac disease tend to develop lactose intolerance, it is better to switch to completely non-dairy lactose-free alternatives to avoid any damage to the intestine<a href="#accordion">[6]</a>.

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Research suggests that people with celiac disease may be more prone to getting inflammatory bowel disease (IBD). Scientists reported a 4-fold increase in the risk of IBD for people with celiac disease, whereas people who have IBD had a 5-fold increased risk of developing celiac disease<a href="#accordion">[8]</a>.

Also, larazotide acetate has been under vigorous research and has reached Phase 3 clinical trials. The drug received &lsquo;fast track&rsquo; designation from the FDA and is targeted towards people who still face the onset of symptoms despite following a gluten-free diet. It works by tightening the adhesions between cells that form the lining of the small intestine. This is required because the junctions are forced to break down due to gluten consumption, making space between the interstitial cells<a href="#accordion">[9]</a>.

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Key Points

<ul>
	<li>Also known as celiac sprue, celiac disease refers to the body&rsquo;s inability to digest gluten.&nbsp;</li>
	<li>The autoimmune disorder involves damaged small intestines because gluten targets the junctions between the cells, leading to spaces between the cells.</li>
	<li>There are 3 types of celiac disease: classic celiac disease, non-classic celiac disease, and silent celiac disease.</li>
	<li>The symptoms of the disease include: nausea, vomiting, abdominal pain, loose stools, <a href="https://www.merisehat.pk/disease/constipation" target="_blank">constipation</a>, etc. The symptoms differ in children and have a greater impact on their growth.</li>
	<li>The main cause of the disease has been linked to the presence of DQ2 and DQ8 genes. While not everyone with the genes gets celiac disease, 3% of the total population with those genes do.</li>
	<li>The diagnosis involves biopsy and examination of the small intestine to determine the type and the severity of the disease.&nbsp;</li>
	<li>There is no cure out there yet. Celiac disease requires a lifestyle change that involves completely eliminating gluten from the diet.</li>
</ul>

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[1] Celiac disease: Symptoms, causes, treatment &amp; diagnosis. Cleveland Clinic. (n.d.).

[2] Mumtaz Ali, Khalid Mahmood, Pervez Khan. Journal of Ayub Medical College Abbottabad 21-3.

[3] Different types of coeliac disease. Schär.

[4] Symptoms &amp; causes of celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases.

[5] Treatment of celiac disease: University of Chicago Celiac Disease Center. University of Chicago Celiac Disease Center |

[6] Celiac disease: Care instructions. MyHealth.Alberta.ca Government of Alberta Personal Health Portal.

[7] Meijer C, Shamir R, Szajewska H, Mearin L. Celiac disease prevention. Frontiers in Pediatrics. 2018;6.

[8] Mårild K, Söderling J, Lebwohl B, et al. Association of Celiac Disease and inflammatory bowel disease: A nationwide register-based Cohort Study. American Journal of Gastroenterology. 2022;117(9):1471-1481.

[9] Slifer ZM, Krishnan BR, Madan J, Blikslager AT. LARAZOTIDE acetate: A pharmacological peptide approach to tight junction regulation. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2021;320(6).