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Definition of Celiac Disease

Celiac disease is an autoimmune illness of the small intestine. It affects the digestive system when food containing glutenin or gliadin proteins is ingested. The glutenin proteins are found in cereals like barley, rye and wheat. Celiac disease harms the inside layer of the small intestine and hinders the absorption of nutrients from food. A person suffering from celiac disease can become malnourished regardless of how much food is consumed.

The immunological reaction causes inflammation that destroys the lining of the small intestine. This reduces the absorption of dietary nutrients and can lead to symptoms and signs of nutritional, vitamin, and mineral deficiencies. Other names for celiac disease include sprue, nontropical sprue, gluten enteropathy, and adult celiac disease.

Celiac disease is common in European countries, particularly in Ireland, Italy, Sweden, and Austria. In Northern Ireland, for example, one in every three hundred people has celiac disease. In Finland, the prevalence may be as high as one in one hundred people. Celiac disease also occurs in North America at about one in every three thousand people. Unfortunately, most population studies underestimate the prevalence of celiac disease because many patients who develop it have few or no symptoms until later in life. In fact, a recent study in the United States suggests that the prevalence of celiac disease in the United States is similar to Europe.

Symptoms of Celiac Disease

The typical symptoms of celiac disease may vary from person to person. Though the disease attacks or affects the digestive system or the small intestine, the symptoms may occur in any other part of the body. Celiac disease affects adults, children and even infants. In the case of infants and young children celiac disease affects the digestive system only.

The three major categories of dietary nutrients are carbohydrates, proteins, and fat. Absorption of all of these nutrients can be reduced in celiac disease. However, fat is the most commonly and severely affected nutrient. Most of the gastrointestinal symptoms and signs of celiac disease are due to the inadequate absorption of fat (fat malabsorption). Gastrointestinal symptoms of fat malabsorption include diarrhea, malodorous flatulence (foul smelling gas), abdominal bloating, and increased amounts of fat in the stool (steatorrhea).

The general symptoms of celiac disease in children and infants are:

• Vomiting
• Constipation
• Weight loss
• Delayed growth
• Abdominal bloating with pain
• Foul smelling and pale fatty stool
• Chronic diarrhea
• Irritability

If a child demonstrates some of these symptoms they may have celiac disease. Children with celiac disease may suffer from delayed growth resulting from malnutrition, delayed puberty, and dental problems.

In adults the symptoms of celiac disease may not start in the digestive system. Some of the symptoms observed in adults are:

• Bone loss or osteoporosis, especially in women
• Mysterious iron deficiency in blood causing anemia
• Itchy numbness in the hands and feet
• Bone or joint pain
• Fatigue
• Arthritis
• Depression and anxiety
• Infertility and recurrent miscarriage
• An itchy and/or painful skin rash known as dermatitis herpetiformis
• Seizures
• Recurring abdominal bloating and pain
• Chronic diarrhea
• Weight loss
• Pale, foul-smelling stool
• Gas
• Behavior changes
• Muscle cramps
• Pale sores inside the mouth, called aphthus ulcers
• Tooth discoloration or loss of enamel
• Missed menstrual periods (often because of excessive weight loss)

Symptoms due to malnutrition and vitamin or mineral deficiencies include:

• Weight loss and fluid retention - Weight loss is the direct result of inadequate absorption of carbohydrates, proteins and fat. However, weight loss may not always occur because patients with celiac disease often have enormous appetites that compensate for the reduced absorption of nutrients. Moreover, weight loss can be masked by fluid retention. Fluid retention occurs in advanced malnutrition because the reduced absorption of protein results in low protein levels in the blood. High protein levels in the blood are necessary to keep fluid from leaking out of blood vessels and into the body's tissues. When blood protein levels fall as in celiac disease, fluid leaks into many tissues (edema) but particularly the ankles and feet, which swell due to the edema.
• Anemia - Lack of absorption of vitamin B12 and iron can lead to anemia.
• Osteoporosis - Lack of absorption of vitamin D and calcium can lead to osteoporosis and bone fractures.
• Easy bruising - Lack of absorption of vitamin K can lead to diminished ability of blood to clot and hence to easy bruising or excessive bleeding.
• Peripheral neuropathy (nerve damage) - Vitamin deficiencies of B12 and thiamine may contribute to nerve damage resulting in poor balance, muscle weakness, and numbness and tingling in the arms and legs.
• Infertility - Untreated celiac disease can lead to infertility in women, lack of menses (menstruation), spontaneous abortions and infants with low birth weight.
• Muscle weakness - Lack of absorption and low levels of potassium and magnesium can lead to severe muscle weakness, muscle cramps, and numbness or tingling sensations in the arms and legs.

There have been cases where the patient showed none of the symptoms of celiac disease but suffered from it for a long time. If left untreated celiac disease may eventually lead to severe liver diseases or intestinal cancer. Sometimes people suffering from celiac disease have no gastrointestinal symptoms at all. Statistics say out of one hundred patients with celiac disease just a little over ten percent shows the classical obvious symptoms of malnutrition such as diarrhea, weight loss, and various other nutritional deficiencies. Some patients suffering from celiac disease do not show any regular symptoms of the disease and thus do not get properly treated. Celiac disease is often misdiagnosed, delaying treatment.

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