Celiac Disease (Gluten Intolerance): Causes, Symptoms & Treatment

Celiac disease, better known as gluten intolerance, gluten allergy, or indigenous sprue, refers to an autoimmune disease of the lining of the small intestine.

What is celiac disease?

Celiac disease or gluten intolerance is genetic and affected people have the condition throughout their lives. It can occur as early as childhood or as late as adulthood. Environmental factors such as stress and infectious diseases can promote celiac disease. Gluten is present in many types of grain, such as rye, wheat, spelt, malt, oats or green spelt. There is debate among medical experts as to whether a missing enzyme may be the cause of celiac disease.

Causes

The cause of celiac disease is thought to be genetic predisposition. This involves an autoimmune reaction, specifically an antigen-antibody reaction to gluten in foods. Similar to an allergy, this leads to an overreaction of the immune system. As the immune system constantly fights against the gluten, inflammation of the mucosa of the small intestine then occurs as a consequence. In a healthy person, the surface of the small intestinal mucosa increases due to numerous mucosal folds (small intestinal villi), this ensures complete absorption of nutrients from our food into the blood. Celiac disease damages the villi of the mucosa of the small intestine and they flatten. As celiac disease progresses, the villi of the small intestine completely regress. Nutrients can no longer be sufficiently absorbed and transported into the blood. As a result, various deficiency symptoms can occur.

Symptoms, complaints and signs

Celiac disease manifests itself in a variety of non-specific symptoms that can vary considerably from patient to patient. Medical experts therefore call the disease the “chameleon of gastroenterology.” The first signs are digestive disorders such as cramp-like abdominal pain, flatulence, diarrhea or constipation after eating foods containing gluten. The most common complaints include weight loss, bloating, nausea and vomiting. Those affected often also complain of loss of appetite and heartburn. More than 50 percent of celiac disease patients experience symptoms that do not affect the gastrointestinal tract. Due to malabsorption in the small intestine, sufferers suffer from iron deficiency, which results in pallor, fatigue and anemia. The psyche can also be affected by this immunological disease of the small intestine: Some sufferers experience irritability, moodiness, anxiety or depression. Directly causally related to celiac disease is dermatitis herpetiformis Duhring. It is a chronic blistering skin disease associated with excruciating itching. The rash mainly affects the extensor sides of the extremities, knees and elbows, the hairy scalp and the buttocks. Suffering children who do not follow a gluten-free diet have an increased risk of developing mental and physical disorders. These can take the form of ADHD, learning disabilities, tooth enamel defects and growth delays.

Diagnosis and progression

If gastrointestinal symptoms are present, there are two different ways to test for celiac disease. First, the doctor can draw blood to test for antibodies to components of gluten. If these antibodies are present, it is a case of celiac disease. The antibody test is not recommended for children, as it is of limited use in these cases. The second possibility to detect celiac disease is a biopsy of the small intestine. In this case, a sample is taken from the mucosa of the small intestine. The patient is given a local anesthetic and swallows a tube to which a capsule is attached. The tube is passed through the esophagus and stomach into the small intestine, where the sample is taken. The sample is examined under a microscope for inflammation. Symptoms and celiac disease include diarrhea, bloating, nausea, vomiting, depression, loss of appetite, weight loss, muscle pain, weakness and fatigue. Babies and young children often have impaired growth, underdeveloped teeth, often exhibit whiny facial expressions and may develop muscle weakness. These symptoms are often not taken seriously and certainly not associated with celiac disease. For this reason, in many cases the disease is only recognized late.Complicating the correct diagnosis is the fact that several symptoms can occur at the same time. Therefore, numerous misdiagnoses or incorrect treatments of celiac disease occur. The symptoms of celiac disease usually do not occur simultaneously and are often not specific. Very often, affected individuals suffer only from typical gastrointestinal symptoms. If celiac disease is recognized too late or no treatment is given, deficiency symptoms and chronic infectious diseases are often the result; celiac disease weakens the entire organism until it is completely emaciated.

Complications

Celiac disease is associated with complications mainly when the affected person does not consistently follow the gluten-free diet prescribed by the doctor. In this case, there is an increased risk of various secondary and concomitant diseases, including type 1 diabetes mellitus, rheumatoid arthritis, and various autoimmune diseases of the thyroid gland. In addition, patients with celiac disease who, contrary to all recommendations, consume foods containing gluten are more likely to develop T-cell lymphoma, a malignant disease of the lymphatic system. At the beginning of therapy, many sufferers complain of complications such as abdominal pain and diarrhea. These complaints are usually caused by the mucous membrane of the small intestine undergoing reconstruction and are easily treatable – provided that the patient informs the attending physician immediately so that he or she can take the necessary steps. If the accompanying symptoms of the therapy are completely ignored, on the other hand, further complications such as intestinal obstruction or disturbances in the electrolyte balance are to be expected. If the patient adheres to his gluten-free diet consistently and, above all, over the long term, the prognosis is very good. In this case, celiac disease also has no effect on life expectancy. Instead, the inflammatory processes regress completely over the course of a few weeks to months. Only if it is a so-called diet-resistant celiac disease, additional immunosuppressants (drugs that throttle the immune system) must be administered.

When should you go to the doctor?

If health changes occur after ingesting food, they should be monitored further. In case of repeated bloating, diarrhea, vomiting or nausea, the abnormalities should be discussed with a physician. The affected person should be able to summarize well which foods or meals he has eaten. If abnormalities or parallels are noticed, these should be reported to the physician. The development of cramps, a general feeling of illness and malaise indicate a health disorder. If there is an increase in the symptoms or if the health disorders occur at regular intervals, a doctor should be informed. If there is a loss of appetite, a decrease in weight, internal weakness and sleep disturbances, the affected person needs medical care. Medical tests must be performed to determine the cause. In case of constipation, a feeling of fullness, fatigue or an inner irritability, a visit to the doctor is advised. States of anxiety, mood swings or other emotional abnormalities are other health disorders that should be further investigated. In case of a depressive state, apathy or loss of zest for life, consultation with a physician should be sought. If there are changes in the appearance of the skin, itching, cognitive impairment or disorders of the enamel, a doctor is needed. If children show delays in development or growth, a medical examination is also advised.

Treatment and therapy

Celiac disease is not curable. It is only possible to alleviate the symptoms. To support the mucous membrane of the intestine, it is necessary to avoid foods containing gluten. Cereal products, pasta, puddings, cookies, cakes, beer, pizza and chocolate contain plenty of gluten. Vegetables, fruit, rice, salad, nuts, dairy products, vegetable oils or wine are suitable for people with celiac disease. In health food stores and now also in many supermarkets, a wide range of gluten-free packaged foods is available, which must be labeled “gluten-free”. Those who do not want to do without grains despite celiac disease will find alternatives in millet, buckwheat, soy, carob flour, amaranth or quinoa.The probability that children of a parent with celiac disease will also develop celiac disease is 10%. Breast milk is said to prevent celiac disease from progressing in the infant and later in the young child. It is advisable for those with celiac disease to visit their doctor at least once a year to have their blood checked for levels of vitamin B12 and vitamin D and to have their weight monitored. Those affected can also take active precautions themselves by informing themselves comprehensively about their disease. Guidance is provided by the German Celiac Society (DZG), which also has an Internet presence.

Prevention

So far, there are no procedures or possibilities to prevent celiac disease completely. Concerned parents must independently request a preventive examination for babies and young children from their pediatrician. Furthermore, people with suspected celiac disease should pay attention to the symptoms and complaints listed above and then consult a doctor. For babies, it makes sense to breastfeed at least until the sixth month of life and to avoid gluten-containing foods themselves during this time.

What you can do yourself

After a diagnosis of celiac disease, a major change in diet is imminent. At first glance, this seems daunting. Gluten-containing are all products that contain wheat, rye, barley, oats, spelt, green spelt, urkorn, kamut or emmer. Commercially available pasta products such as rolls, pasta, bread, cakes and pastries also contain gluten. Ready-made meals and soups also cannot be eaten. But 90 percent of all foods are naturally gluten-free, so changing your diet doesn’t have to be difficult. Potatoes, rice, quinoa, millet, buckwheat and amaranth are just a few foods that can be eaten as a side dish instead of pasta – in other words, a whole lot. Also any fruit, vegetables and nuts do not contain gluten. Thus, everyday life can proceed normally even after the diagnosis of celiac disease. Nevertheless, it is difficult to find suitable meals when out and about, as flour is used as a thickener in most sauces. Therefore, it is advisable to prepare meals the day before and take them with you. If one is invited to a meal, it becomes equally difficult. Acquaintances and friends should therefore be informed about the disease, or one contributes something to the meal. You should also be able to recognize the first signs of an attack and be able to act if you do eat food containing gluten.