Symptoms
Symptoms of celiac disease can vary widely from person to person and may differ in children and adults. Some people may have no symptoms at all, while others experience severe symptoms.
Gastrointestinal Symptoms: Diarrhea, abdominal pain, bloating, gas, constipation, nausea, vomiting, pale, foul-smelling, or fatty stools.
Non-Gastrointestinal Symptoms: Anemia (usually iron deficiency), fatigue, bone or joint pain, arthritis, osteoporosis or osteomalacia, skin rash (dermatitis herpetiformis), mouth ulcers, headaches, nervous system issues (such as numbness or tingling in the hands and feet, problems with balance, and cognitive impairment), failure to thrive in infants, delayed growth in children, weight loss, acid reflux and heartburn, damage to dental enamel, reduced function of the spleen (hyposplenism).
Neurological symptoms: Difficulty with balance, poor coordination, headaches, peripheral neuropathy (numbness, tingling, or pain in the hands and feet), cognitive impairment ("brain fog").
Causes
Celiac disease is caused by a combination of genetic and environmental factors. The primary trigger is gluten consumption.
Genetics: Most people with celiac disease have specific genes (HLA-DQ2 and/or HLA-DQ8). However, having these genes does not guarantee that you will develop celiac disease. About 30% of the general population carries one of these genes.
Gluten Exposure: In genetically predisposed individuals, gluten triggers an immune response that damages the small intestine.
Other Factors: Gut bacteria, infant-feeding practices, and infections may also play a role in the development of celiac disease, but the exact mechanisms are not fully understood.
Medicine Used
There is no medication to cure celiac disease. The primary treatment is a strict, lifelong gluten-free diet.
Gluten-Free Diet: This is the cornerstone of celiac disease management. It involves avoiding all foods and products containing wheat, barley, and rye.
Vitamin and Mineral Supplements: Nutrient deficiencies are common in people with celiac disease due to malabsorption. Supplements such as iron, calcium, vitamin D, vitamin B12, zinc, and folate may be recommended.
Steroids: In severe cases where the small intestine is severely inflamed, corticosteroids may be prescribed to reduce inflammation. These are usually used for a short period.
Dermatitis Herpetiformis Treatment: A medication called dapsone can be prescribed for the skin rash associated with celiac disease.
Precautions
The most important precaution for individuals with celiac disease is strict adherence to a gluten-free diet.
Read Labels Carefully: Always check the ingredient lists of all foods and products to ensure they do not contain wheat, barley, rye, or any gluten-containing derivatives.
Avoid Cross-Contamination: Prevent cross-contamination by using separate cooking utensils, cutting boards, and toasters.
Eat at Gluten-Free Restaurants: When eating out, choose restaurants that offer gluten-free options and have trained staff knowledgeable about celiac disease.
Educate Yourself: Stay informed about hidden sources of gluten in foods, medications, and other products.
Consult a Dietitian: Work with a registered dietitian specializing in celiac disease to develop a balanced and nutritious gluten-free meal plan.
Be Cautious with Oats: While oats themselves don't contain gluten, they are often processed in facilities that also handle wheat, leading to cross-contamination. Choose certified gluten-free oats.
Personal Care Products: Some personal care products like lipsticks or shampoos might contain gluten. While topical application is less likely to cause a reaction, using gluten-free options is recommended to avoid accidental ingestion.
How long does an outbreak last?
Celiac disease isn't characterized by outbreaks in the traditional sense. It's a chronic condition. However, symptoms can flare up after gluten ingestion. The duration of symptoms after exposure varies depending on the amount of gluten consumed, the individual's sensitivity, and the extent of intestinal damage.
Symptoms may start within hours or days after gluten exposure.
They can last for several days or even weeks as the immune system reacts and the small intestine is damaged.
Complete recovery can take weeks or months, especially if the intestinal damage is significant.
Continued gluten exposure will lead to ongoing symptoms and prevent healing.
How is it diagnosed?
Diagnosis of celiac disease typically involves a combination of blood tests and an intestinal biopsy.
Blood Tests: Serology tests (blood tests) detect antibodies that indicate an immune reaction to gluten. The most common tests include:
Tissue Transglutaminase Antibody (tTG-IgA)
Endomysial Antibody (EMA-IgA)
Deamidated Gliadin Peptide (DGP IgA and IgG)
Total Serum IgA (to rule out IgA deficiency, which can affect the accuracy of IgA-based tests)
Genetic Testing: HLA-DQ2 and HLA-DQ8 genetic testing can identify individuals who have the genes associated with celiac disease. This test is useful in certain situations, such as when blood test results are unclear.
Intestinal Biopsy: If blood tests are positive, an upper endoscopy is performed to take a small tissue sample (biopsy) from the small intestine. The biopsy is examined under a microscope to look for damage to the villi. The patient must be on a gluten-containing diet for an accurate result.
Capsule Endoscopy: In some cases, capsule endoscopy may be used to visualize the small intestine.
Skin Biopsy: A skin biopsy may be performed to diagnose dermatitis herpetiformis.
Timeline of Symptoms
The timeline of symptoms in celiac disease can vary widely. Some people may experience symptoms soon after consuming gluten, while others may have a delayed onset. It depends on multiple factors.
Onset: Symptoms may appear at any age, from infancy to adulthood.
Immediate Symptoms: Within hours or days of gluten ingestion, some individuals may experience gastrointestinal symptoms such as abdominal pain, bloating, diarrhea, or nausea.
Delayed Symptoms: Other symptoms, such as fatigue, anemia, bone pain, or neurological problems, may develop gradually over time as the small intestine becomes more damaged and nutrient absorption is impaired.
Dermatitis Herpetiformis: The characteristic skin rash (dermatitis herpetiformis) may appear as itchy blisters, often on the elbows, knees, buttocks, or scalp.
Variability: The severity and type of symptoms can vary significantly from person to person and may fluctuate over time.
Remission: Symptoms typically improve or resolve completely after starting a strict gluten-free diet. However, it may take weeks or months for the small intestine to heal completely.
Important Considerations
Lifelong Management: Celiac disease requires lifelong adherence to a strict gluten-free diet. Even small amounts of gluten can trigger symptoms and cause damage to the small intestine.
Silent Celiac Disease: Some people with celiac disease may have no noticeable symptoms (silent celiac disease). However, they are still at risk of long-term health complications and require a gluten-free diet.
Increased Risk of Other Conditions: Untreated celiac disease can increase the risk of other health problems, such as anemia, osteoporosis, infertility, and certain types of cancer.
Regular Monitoring: People with celiac disease should have regular check-ups with their healthcare provider to monitor their condition and screen for complications.
Support Groups: Joining a celiac disease support group can provide valuable information, emotional support, and practical tips for managing the condition.
Family Screening: Because celiac disease has a genetic component, family members of individuals with celiac disease should be screened for the condition.
Consult Healthcare Professionals: A proper diagnosis and treatment plan should be managed by qualified healthcare professionals, including a gastroenterologist and a registered dietitian.
Gluten-Free Labelling: Be aware of gluten-free labelling standards in your region. Labels can help to identify safe foods.