What's Going Around?
It has been held within the scientific community that Celiac Disease is rare in the United States, but that idea is about to change. Recent serologic tests and large scale screenings in United States as compared to Europe, revealed that Celiac Disease (CD) in symptomatic patients and not-at-risk subjects was similar to that reported in Europe, making Celiac Disease one of the most common genetic diseases of humankind. Celiac Disease is an immune-mediated disease of the intestines triggered in genetically susceptible individuals by the ingestion of gluten-containing grains such as wheat, barley and rye. In at-risk groups the prevalence of CD was 4.5% in first-degree relatives, 2.5% in second-degree relatives. The overall prevalence of CD in not-at-risk groups was 0.75%. Celiac Disease represents a unique example of an immune-mediated disease for which early diagnosis and dietary treatment can prevent severe, sometimes life threatening complications.
Given the common European ancestry of a large portion of the US population, it is likely that Celiac Disease is more prevalent than currently recognized. Celiac disease affects people differently. Some people develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed. The longer one was breastfed, the later symptoms of celiac disease appear, and the more atypical the symptoms. Other factors include the age at which one began eating foods containing gluten and how much gluten is eaten.
Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression. In fact, irritability is one of the most common symptoms in children.
Symptoms of celiac disease may include one or more of the following:
- recurring abdominal bloating and pain
- chronic diarrhea
- weight loss
- pale, foul-smelling stool
- unexplained anemia (low count of red blood cells)
- bone pain
- behavior changes
- muscle cramps
- delayed growth
- failure to thrive in infants
- pain in the joints
- tingling numbness in the legs (from nerve damage)
- pale sores inside the mouth, called aphthus ulcers
- painful skin rash, called dermatitis herpetiformis
- tooth discoloration or loss of enamel
- missed menstrual periods (often because of excessive weight loss)
Anemia, delayed growth, and weight loss are signs of malnutrition--not getting enough nutrients. Malnutrition is a serious problem for anyone, but particularly for children because they need adequate nutrition to develop properly. Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.
The only treatment for celiac disease is to follow a gluten-free diet. That is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed in 6 months, but may take up to a year.
The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve. A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diets. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease.
If a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.