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What is Celiac Disease?
You may have heard these terms:
- Celiac Sprue
- Non-Tropical Sprue
- Gluten-Sensitive Enteropathy
- Celiac Syndrome
- Gliadin-Sensitive Enteropathy
All of these are different names for the same disorder, but what exactly is this disorder?
Celiac disease is an autoimmune condition and considered to be a permanent intolerance to GLUTEN found in wheat, barley and rye. Oats are still questioned due to the processing procedures. Oats may sometimes be processed on the same conveyer belt as wheat or other grains that cause a reaction in the gut. Ingestion of gluten produces inflammatory injury to the mucosa of the small intestine. Gluten is a toxin for people with Celiac Disease, as it triggers intestinal cells to release cytokines, interleukin 4 and tumor necrosis factor, all of which impacts the intestine’s ability to function properly.
Celiac disease was once thought of as a disease with only GI symptoms. Most physicians recognize the classic symptoms of celiac disease: diarrhea and/or constipation, bloating, weight loss, anemia, chronic fatigue, weakness, bone pain, and muscle cramps. Physicians may not be aware that celiac disease frequently presents with other symptoms that do not involve the small intestine. Education is very important for patient as well as for doctor.
It is now recognized that the disease is a multi-symptom, multi-system (organ) disease. Celiac disease also does not routinely present with the “textbook” symptoms that physicians learn. Therefore most doctors do not look at this disease as often as others
More often it presents with symptoms that can mimic other problems.
Let’s talk about the symptoms of Celiac Disease. (Adult Onset, Latent or “Asymptomatic”)
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Decreased feelings of well being |
Anemia |
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Easily fatigued |
Recurrent Miscarriages |
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Depression |
Chronic Hepatitis |
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Irritability |
Ataxia (loss of coordination) |
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Iron deficiency |
Bone & Joint Pain |
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Osteoporosis |
Reduced bone density |
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Short Stature |
Infertility |
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50% have no GI symptoms |
Dental Enamel Defects |
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Reflux |
Mouth ulcers |
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Fibromyalgia |
Migraine headaches |
Other extraintestinal features include:
Gastrointestinal – Typical symptoms; now less common
Dermatologic – Dermatitis herpetiformis, psoriasis
Neurological – Peripheral neuropathy, epilepsy, ataxia (loss of coordination)
Psychologic – Can affect schizophrenia, “fuzzy thinking” behaviors
Endocrine – Diabetes type 1 is related; thyroid conditions, myasthenia gravis
Reproductive – Can affect fertility and miscarriage
Hematologic – Anemia
Liver - Isolated hypertransaminasemia, primary bilary cirrhosis
Orthopedic – Bone & joint pain; osteopenia; osteoporosis
Cardio/vascular – Cardiomyopathy, Vasculitis, Pericarditis,
Celiac disease is twice as common as Crohn’s disease, Ulcerative colitis and Cystic Fibrosis combined. Exposure to gluten causes the intestinal villi (finger-like projections) to flatten and no longer absorb vitamins, minerals, nutrients, fats, carbohydrates, proteins, at the correct levels for the body’s health.
There are so many disorders this list could fit. So how do you narrow down from hundreds of different problems what yours could be? That is a good question and one we are willing to address.
First, be proactive in your health care. Be a partner with your doctor and if you are with a doctor that does not believe this way, find another doctor. You must feel comfortable with your doctor and be able to communicate with him effectively. You must be able to bring information to him you feel is important for your health care.
Second, you will most likely have to go through some tests to see what it is not, before you find what it is, so be patient. A simple yet great way to start is an IgG food toxicity test which will test you for not only gluten, but 195 other foods and spices you may have sensitivity to. Why is this test beneficial? Just take a look at the symptom otology page how your body reacts to IgG food allergies. What do allergies do? Click here for more info.
Third, your doctor may take a health history of your family. Find out about your first and second degree relatives and the diseases they have had. That could help your doctor in linking things together. Note symptoms on paper before you go to him so you don’t forget. Many times we get in the office and get fuzzy headed and forget many things that might be helpful for your doctor.
Fourth, it is very important for you to get the right testing done. The following are the recommended tests from the Celiac Research Centers.
Blood Screening Antibody Tests:
IgG AGA Antigliadin Antibodies (good sensitivity)
IgA AGA Antigliadin Antibodies (good sensitivity)
EMA Endomysial Antibodies (Excellent sensitivity, 97-100%, & 98-99& specificity, but test is analyzed by a person)
tTG Tissue Transglutaminase (Good sensitivity & specificity, but test is analyzed by a machine)
Total Serum IgA (Needed because 3 of above tests are IgA-mediated, and many people in the general population are IgA deficient)
Use all 5 tests in the panel to see whole picture. There are still a lot of false positives and false negatives.
Use reliable labs with experience in these specialized tests. Contact us for further information on labs and testing.
Endoscopy Procedure is the “gold standard” of diagnosis. Multiple tissue samples are needed. This is very important.
HLA genetic tests for DQ2 and DQ8 may be valuable. DQ2 is found in 96% of celiac patients; DQ8 is found in remaining patients. If person does not have either of these genes, then they can’t develop CD.
STRONGLY CONSIDER REFERRAL FOR BIOPSY WHEN:
a. Postive EMA with or without positive antigliadin antibodies
b. Positive tTG with or without positive antigliadin antibodies
c. Positive antigliadin IgG in an IgA deficient patient
d. Markedly elevated antigliadin antibodies in a very young child (under 3 yrs.)
e. Refer to gastroenterologist for further review when clinical presentation
suggests C.D. regardless of serology.
You don’t just suddenly come up with celiac disease one day. Here are some factors that play into it directly.
!. One must have the correct genetic susceptibility being the genes – DQ8 and
DQ2 Haplotypes. 95% of celiacs have DQ8 and /or DQ2
2. You must also be ingesting gluten.
3. There must be some type of trigger:
a. an environmental trigger that is unknown, seemingly related to an infection
b. stress after operations
c. pregnancy
d. stressful job
e. divorce
The prevalence of Celiac Disease in the United States is 1 in 133.
First degree relatives of patients with CD are 1 in 21.
It could be helpful for you if you contact a celiac support group as you will gain much helpful information and advice on everything relating to Celiac Disease.
Click on the helpful link below for food sources, recipes, celiac support site, etc.
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