CELIAC DISEASE: DIAGNOSIS AND TREATMENT

POSTED ON 09/03/2019

Over the last several years, an increasing number of people have begun to cut gluten out of their diets. For some people, this is just about cutting the carbs to trim down, or because they may feel better when they eat a diet containing less gluten. For others, there is a far more important reason to avoid gluten. No matter how tasty or delicious baked goods may be, if you have celiac disease, consuming the gluten found in many grain flours will lead to an uncomfortable experience at the least, and could be a road to serious health issues. 

WHAT IS CELIAC DISEASE?

Celiac disease is a serious autoimmune disorder that stems from an allergic reaction to gluten proteins. Gluten is naturally found in grains like barley, rye, and wheat. Even grains that are less common in the United States, such as spelt, contain forms of gluten. Since these grains are used in a large number of foods, having celiac disease can mean you need to make serious changes to your diet. Pasta, cereal, breads, pizza, and other baked goods are commonly made with gluten-rich grains like wheat. Wheat and barley are also a major component in brewing beer, which can mean individuals with celiac disease also need to be careful what they drink. 

Research is still being done into the exact cause of celiac disease, but there is evidence to suggest certain genetic markers are present in your DNA when you are predisposed to celiac disease. Symptoms can appear in childhood, though in many cases people do not become symptomatic until later in life. Many people go for long periods without a conclusive diagnosis, as the symptoms of celiac disease can manifest slowly over time, and may take a while to become severe enough for you to seek medical attention. 

WHAT ARE THE SYMPTOMS OF CELIAC DISEASE?

If you have celiac disease, sometimes called celiac sprue, eating foods containing gluten over long periods will eventually cause you to become sensitized to ingesting certain proteins. Once you have become sensitized, consuming even a small amount of gluten will cause the small intestine to become irritated and inflamed. This inflammation can cause bloating and pain commonly associated with food allergies, but the story is deeper than a bit of uncomfortable abdominal swelling.

The villi, small protrusions lining the small intestine, can become damaged when your intestine is inflamed. Since the villi are responsible for absorbing nutrients from your food and passing them into your bloodstream, anything that damages the villi can cause effects throughout the body. 

Eating one tasty croissant will not immediate destroy your health, but continued exposure to gluten proteins can eventually lead to a host of problems if you have celiac disease. Some people may be surprised to learn many symptoms that seem unrelated are caused by irritation in the small intestine. The effects of malabsorption of nutrients affect the entire body, making celiac disease a serious concern. These symptoms can include:

  • skin rashes
  • bloating and gas
  • iron deficiency
  • fatigue
  • weight loss
  • chronic diarrhea
  • headaches
  • constipation
  • joint pain
  • failure to thrive in infants and young children

Since some of these common symptoms may have other causes, it can sometimes take persistence to finalize a diagnosis. Abdominal pain and bloating can be caused by lactose intolerance, irritable bowel syndrome, or other gastrointestinal conditions. Depression, numbness in the hands and feet, and bone pain are all symptoms of celiac disease, but could also have other causes. Tracing your symptoms down to your diet may not be the first thing you would think of, but all of these symptoms can find their root in the inflammation of the lining of the small intestine. 

Of all the symptoms of celiac disease, one of the few visible and recognizable ones is a skin condition called dermatitis herpetiformis. This rash, which can appear on the elbows, back, buttocks, knees or even scalp, is a response by your immune system to the irritation you are experiencing from eating gluten. Like the other symptoms of celiac disease, though, dermatitis herpetiformis can be caused by other immune responses, so these telltale rashes are not a guarantee you have celiac disease.

HOW IS CELIAC DISEASE TREATED?

Even if your doctor suspects you may have celiac disease, he or she will likely not recommend you remove gluten from your diet until more conclusive tests can be performed. It may seem counter-intuitive not to immediately switch to a gluten-free diet, but the need to properly identify the source of the irritation in your small intestine means you will be asked to maintain your normal diet while a diagnosis is being confirmed.  

Serological tests to look for antibodies in your blood and genetic testing to look for particular antigens can help narrow down your diagnosis. Ultimately, even with the results of blood tests, your doctor may recommend an endoscopy to verify for certain if there is telltale damage to the lining of your small intestine. Whether a traditional or capsule endoscopy is used, the goal is the same—to get a camera into your intestine to verify whether the villi are irritated or damaged. 

Since celiac disease involves your body reacting to a specific protein, the first step in active treatment is to begin a strict gluten-free diet that will eliminate gluten entirely from the food you eat. For many people, the simple act of aggressively and completely cutting gluten out of their diet will be enough to make many symptoms begin to subside. 

Maintaining a gluten-free diet can be more challenging than you think. Ordering a salad instead of a burger is an easy step, but gluten is hiding in many places you may not expect. Some food starches, stabilizers, and preservatives contain gluten. Many salad dressings contain gluten, so being sure to ask your waiter or check the ingredients at the grocery store is important. Gluten can also be found in over-the-counter medications and even prescriptions. Some vitamins and minerals, and even nutritional supplements, also contain gluten. 

Even if you have a handle on your diet and medications, you may still be surprised by gluten lurking in other places. Mouthwash and toothpaste sometimes contain gluten, as does a selection of beauty products including certain lipsticks. Even the glue on stamps can contain gluten, which can be a problem if your gluten sensitivity is particularly severe. 

It is important to be careful about finding medications and supplements that are gluten-free, especially because your doctor or dietitian may prescribe various vitamins and minerals. This is particularly true if your symptoms include anemia or other nutritional deficiencies. A short list of supplements your doctor might prescribe includes:

  • Zinc 
  • Iron
  • Folate
  • Copper
  • Vitamin D, 
  • Vitamin B-12
  • Vitamin K

MEDICATIONS TO CONTROL INTESTINAL INFLAMMATION

Unlike some other medical conditions that require medications for the ongoing management of symptoms, celiac disease can often be managed without medication. There are cases, however, when drugs are necessary to help manage some symptoms. When medications are prescribed, it is usually to control inflammation in your intestines. 

Controlling inflammation with drugs such as budesonide (Uceris, Entocort EC) or azathioprine (Imuran, Azasan) is typically done only if the intestinal damage from inflammation is quite severe, or if you have a condition called refractory celiac disease. This condition, for which there is no known cure, is a variant of celiac disease where the intestine will not heal, even after dietary modification. 

WHERE DO I FIND HELP IF I HAVE CELIAC DISEASE?

As celiac disease becomes more well known, more and more resources are available to help you. This includes restaurants and grocery stores carrying more gluten-free foods. A wide variety or resources and publications are available from medical research centers such as the National Institute of Diabetes and Digestive and Kidney Diseases and the Celiac Disease Foundation. The Celiac Disease Foundation also provides ways for people interested in participating in clinical trials to help further celiac disease research.

Support groups also exist for individuals or family members of those suffering from celiac disease. While you should still rely on medical advice for diagnosis and treatment, support groups can be valuable for tips on maintaining a gluten-free diet, including how to work with wheat alternatives such as quinoa flour, or help on how to modify your life and diet to live well with celiac disease. 

TALK TO YOUR DOCTOR ABOUT CELIAC DISEASE

Simply put, trying to self-diagnose celiac disease is not a good idea. Celiac disease is different than simply having a sensitivity to certain foods. It is also important to remember that lactose intolerance, other gastrointestinal conditions or diseases of the immune system can all share symptoms with celiac disease, making a definitive diagnosis difficult. 

You doctor can perform a blood test and order an endoscopy to verify the source of your symptoms. From there, consulting with a dietitian can help get you on the right track to reducing and managing your symptoms as quickly and safely as possible.  

If you are experiencing bloating and pain—or any of the other symptoms listed above—after eating foods that may contain gluten, make an appointment with Associates in Digestive Health today. We can help guide you through the process of establishing a diagnosis and, if necessary, providing follow-up care as you learn to live with your gluten sensitivity.