Definition

Celiac disease is a digestive disorder that damages the small intestine. It is an autoimmune disease in which the immune system attacks its own healthy body cells. Consuming foods that contain gluten triggers celiac disease. 

This disease can cause long-term digestive problems and prevent the body from obtaining needed nutrition because many foods are prohibited for those affected. It's important to note that celiac disease is different from gluten or wheat intolerance. 

While gluten sensitivity may have symptoms similar to celiac disease, such as abdominal pain and fatigue, there is no damage to the small intestine. Celiac disease also differs from wheat allergy. Allergy conditions do not cause long-term damage to the small intestine. In wheat allergy, symptoms such as itching eyes or difficulty breathing differ from those of celiac disease. 

There are many undiagnosed cases of celiac disease. In the US alone, it is predicted that 2 million people have celiac disease, while it is estimated that 1% of the world's population has celiac disease.

Causes

Celiac disease is triggered by foods containing gluten. Gluten is a protein naturally found in wheat, barley, and rye, and is also present in products like bread, pasta, and cake. Other products containing gluten include packaged foods, lip balm, lipstick, toothpaste, vitamins, nutritional supplements, and medications, although this is rare.

In individuals with celiac disease, consumption of gluten triggers an immune response in the digestive tract. Over time, this reaction damages the layers of the small intestine, preventing it from absorbing certain nutrients. The layers of the small intestine, which should play a role in absorbing vitamins and minerals from food, become damaged. This results in the body being unable to obtain the necessary nutrients to function properly.

Risk factor

Factors such as pregnancy or childbirth, viral infections, severe emotional stress, and surgical procedures can increase the developing of celiac disease.

Celiac disease is usually found in people with:

• A history of celiac disease
• Autoimmune diseases such as:
• Type 1 diabetes, where the pancreas is unable to produce insulin or produces it in small amounts
• Rheumatoid arthritis, characterized by chronic inflammation in several joints throughout the body
• Liver or thyroid disorders
• Addison's disease, where the adrenal glands are unable to produce the required amount of hormones
• Sjögren's syndrome, where the immune system attacks healthy cells that produce saliva and tears, resulting in dry eyes and mouth
• IgA selective deficiency, a condition where the body produces small amounts or none of IgA, an antibody that fights infection
• Genetic disorders such as Down syndrome, Turner syndrome, and Williams syndrome.

Celiac disease can affect children and adults worldwide. In the US, this disease is more frequently diagnosed in whites than in other races or ethnicities. Additionally, it is more commonly diagnosed in women than in men.

Symptoms

The symptoms of celiac disease vary, and some individuals may experience intermittent symptoms. Celiac disease can manifest with digestive problems or other symptoms, with manifestations more commonly found in children than in adults.

The symptoms of celiac disease include:

• Bloating and excessive gas in the digestive tract
• Chronic diarrhea (long-term)
• Constipation
• Lactose intolerance due to damage to the small intestine
• Soft, oily, bulky, and foul-smelling stools
• Nausea or vomiting
• Abdominal pain

In children with celiac disease, the inability to absorb nutrition during the growth period can cause:

• Permanent damage to tooth enamel
• Delayed puberty
• Failure to thrive, resulting in children having low weight or less weight gain than they should for their age
• Slow growth and short stature
• Weight loss
• Unstable mood, easily irritable, and impatience

Some individuals with celiac disease can experience symptoms affecting other parts of the body, such as:

• Eczema (dermatitis herpetiformis), a skin rash that is itchy and blister-like, often appearing on the elbows, knees, buttocks, back, or scalp
• Fatigue
• Joint or bone pains
• Mental disorders like depression or anxiety
• Neurological symptoms
• Headaches
• Balance disorders
• Seizures
• Peripheral nerve disorders
• Reproductive issues in women, including infertility (in both men and women), late menstruation, infrequent menstruation, and recurrent miscarriages
• Symptoms involving the mouth, such as mouth ulcers, dry mouth, or a red, soft, and shiny tongue

These symptoms usually improve and are relieved after adopting a gluten-free diet. However, symptoms may return upon consuming even small amounts of gluten again.

Diagnosis

First, the doctor will conduct a thorough interview about your complaints and symptoms, as well as your medical and family history. The doctor will then perform a physical examination of the abdomen and the entire body, looking for signs of weight loss or developmental issues in children

Generally, doctors will not recommend starting a gluten-free diet until the diagnosis of celiac disease is supported by diagnostic tests. Doctors can conduct diagnostic tests if needed and if the health facility offers them, such as:

• Antibody examinations
• Complete blood tests
• Biopsies or sampling of tissues from the small intestine using an endoscope
• Skin biopsies if there are rashes
• Genetic tests

Management

The doctor will recommend a gluten-free diet, and many will experience symptom improvement after several days to weeks of starting the diet. The doctor will explain the gluten-free diet and may refer the individual to a nutritionist. The nutritionist will explain how to avoid gluten-containing foods and recommend food replacements. Additionally, the affected person will be assisted with:

• Checking food labels for gluten-containing products
• Determining daily meal menus
• Choosing healthy foods and beverages

In addition to a gluten-free diet, the doctor will recommend avoiding sources of gluten such as those found in herbal supplements, nutritional supplements, medications, vitamins, and minerals. Some medications may contain gluten, but usually in small amounts that do not cause symptoms.

Certain products can serve as hidden sources of gluten if accidentally ingested, particularly if placed near the mouth or ingested:

• Plasticine
• Cosmetics
• Lipstick, lip gloss, lip balm
• Skin and hair products
• Toothpaste and mouthwash

Complications

Individuals with celiac disease who do not exhibit symptoms can still experience complications over time if the condition is not treated. Long-term complications of celiac disease include:

• Accelerated osteoporosis or a decrease in bone density, known as osteomalacia
• Anemia or a deficiency in red blood cells
• Malnutrition a condition where an individual does not receive sufficient vitamins, minerals, and other nutrients needed to maintain overall health
• Nervous system disorders
• Issues related to the reproductive system

Rare complications of celiac disease, though they can still occur, are:

• Adenocarcinoma, a type of small intestine cancer
• Liver damage, which can lead to cirrhosis or liver failure
• Non-Hodgkin lymphoma

In rare cases, long-term nutrition absorption disorders can occur even with strict adherence to a gluten-free diet. This condition is called refractory celiac disease, where the small intestine is severely damaged and cannot recover. Individuals may require nutrition through intravenous and specific therapies.

Prevention

While there is currently no known way to prevent celiac disease, early screening is recommended if you have a family member who has been diagnosed with the condition.

When to see a doctor?

You should consult a doctor if you or your child routinely experience digestive issues after consuming foods like bread, pasta, cake, or cookies. Additionally, if your child is significantly shorter or smaller than others of a similar age, seeking medical advice is advisable.

Since celiac disease tends to be hereditary, if you have family members with this condition or if you have risk factors for the disease, it is recommended to consult a doctor for further examination if necessary.

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