Celiac Disease: Common and Often Undiagnosed
By Steven A. Rogers, MD
A recent front-page article in the Ithaca Journal drew needed attention to celiac disease. This
condition, which damages the gastrointestinal (GI) system, affects about one in
140 people. It produces symptoms that go beyond the GI
system and diagnosis can be complicated. Once diagnosed, however, celiac
disease can be well controlled with a restricted diet.
What is celiac disease?
Celiac disease is an allergic reaction to gluten, which is a
protein found in specific grains: wheat, barley, rye, and possibly oats. We
don’t know why this allergic reaction occurs in certain people and not others.
When a person with celiac disease consumes gluten, it breaks down during
digestion and causes inflammation in the intestines. Rice, soy, beans,
potatoes, and tapioca are safe to consume and do not cause inflammation.
What are the symptoms of celiac disease?
The intestinal inflammation in people with celiac disease
causes many GI symptoms, among them diarrhea, excessive gas, and weight loss.
In addition, because people with this condition are not absorbing their food
properly, they often develop iron-deficiency anemia and osteoporosis brought on
by insufficient calcium absorption. Other symptoms include a specific rash on
the skin, changes in liver function, and occasionally muscle and nerve pain.
There is also a link between celiac disease and other autoimmune diseases,
which puts people with celiac disease at a higher risk for problems like
thyroid disease and juvenile diabetes.
Psychological symptoms may include depression, mood changes,
anxiety, and mental fog. Sometimes the cause of psychological symptoms can be
hard to pin down; however, when people with celiac disease successfully avoid
gluten, these symptoms often clear up.
How is celiac disease diagnosed?
Diagnosis can be difficult. If someone has symptoms of celiac
disease, the next step is typically a blood test. This test is very accurate;
however, it requires the patient to eat foods containing gluten for four to six
weeks and this can be very challenging for the patient. If the blood test is
positive for celiac disease, the next step is an endoscopic procedure during
which a little sample of intestinal tissue is obtained to confirm the
inflammation and to determine its extent. There is a genetic test for celiac
disease but this blood test can only suggest the diagnosis, as many people will
test positive and not have celiac disease.
How is celiac disease treated?
The treatment is to adopt a gluten-free diet, which can be
difficult because wheat, barley, and rye are very common ingredients. If you
are able to cook for yourself and avoid gluten, symptoms get all better. We
often refer patients to the dietitians at the Cayuga Center for Healthy Living
(6o7-252-3590) for help. They can give you good advice on what to eat, what to
avoid, and which local restaurants serve gluten-free food. A local bakery based
in East Lansing, A Piece O’ Cake, specializes in gluten free products including
hamburger buns, pizza dough, cakes, and cookies. While promising medications
are currently in development, neither is on the market yet.
There are people with celiac disease who do not have any
symptoms. The condition needs to be treated even in the absence of symptoms
because celiac disease is associated with an increased risk of intestinal
cancer; the chronic inflammation sets the stage for cancer. If you have a first
degree relative with celiac disease (parent, sibling, or your child), there is
a 15 percent chance that you have or will develop this condition so it may be
worth getting tested for it. Your doctor can advise you. A useful on-line
resource is www.celiacsociety.com.
Dr. Rogers is board certified in
internal medicine and gastroenterology, serves on the medical staff of Cayuga
Medical Center, and is in practice with Gastroenterology Associates of Ithaca
where he can be reached at 607-272-5011.