What is Celiac Disease?

Celiac disease, sometimes spelled as coeliac disease, is an autoimmune disease and a genetic disorder.  The word “celiac” comes from the Greek word for abdominal.  Aptly named, the celiac artery, sometimes called the celiac trunk, supplies blood to the stomach, spleen, liver, gallbladder, pancreas, esophagus, and duodenum.  However, celiac disease has little to do with the celiac artery; instead it is an autoimmune disease of the small intestine.  Celiac disease and gluten-free diets are often discussed simultaneously, and below I have researched why.

What is gluten?

Gluten, Latin for “glue,” is a protein found in wheat, barley, rye, spelt, some oats, and a variety of wheat derivatives.  During baking, gluten helps form pockets of air in the bread, giving bread a fluffy, chewy texture.

Fluffy gluten-ful bread / Photo available via CC0

What is celiac disease?

Celiac disease is an immune response in the small intestine.   The small intestine connects the stomach to the large intestine and is the primary absorber of nutrients.  The intestinal walls are covered with small hair like projections called “villi,” which create more surface area for nutrient absorption.  The immune response caused by celiac disease slowly damages the villi, reducing the surface area of the small intestine and making it difficult for the villi to absorb the nutrients.

There is no cure for celiac disease, but a strict gluten free diet helps manage the symptoms and promote intestinal healing.  

Celiac disease is diagnosed at any age, starting as early as babies that are just starting to eat grains in their diet.  The most common age for diagnosis is 40-60 years old [1].   Celiac disease affects about 1% of the American population, but researchers believe that as few as 20% of people with celiac disease are accurately diagnosed [2].

Interestingly, celiac disease can be triggered by a stressful event, such as traumatic injury, surgery, or pregnancy.  Some scientists and doctors suggest that the discovery of celiac disease after a traumatic event is just due to the patient’s closer proximity to medical community leading to a higher likelihood of it being discovered while doing tests for something else.  Other people believe that the traumatic event leads to an increased immune response.  Immune responses are not very precise—it is not targeted to the specific event and are more general.  But in some cases the immune response might manifest itself into celiac disease.

Symptoms

There are over 200 symptoms of celiac disease which affect each individual differently and to varying degrees of severity.  This makes celiac disease extremely hard to diagnose.  Over half of the adult cases do not have the classic gastrointestinal symptoms–diarrhea, bloating, and stomach cramps.  This infographic, courtesy of glutendude.com, lists some of the more common symptoms of celiac disease, with the most common listed in red.

 

Celiac disease symptoms / Image courtesy of Gluten Dude

Diagnosis

Diagnosis can be impossible if the person is already following a gluten free diet.  In a person with celiac disease, eating gluten raises the levels of two specific antibodies in the blood.  The blood testing is specific to those antibodies and would not otherwise be ordered, unless the person is suspected to have celiac disease.  If the person is following a gluten-free diet, the antibodies are not at an elevated level and the person is not diagnosed properly.

Another test can be performed endoscopically.  In an endoscopy, a camera is sent down the throat of a person through their stomach to their small intestine, and then multiple small samples of the walls of the small intestine are removed and analyzed.  The analysis is looking for microscopic damage to the villi. 

The villi of the small intestine become damaged as the immune response progresses (a lymphocyte is a cell associated with the immune system) / Image by Der Lange and available via CC BY-SA 4.0, via Wikimedia Commons

Treatment

There is no cure for celiac disease, but people diagnosed with it can usually live a relatively normal life if following a strict gluten-free diet.  People following a gluten-free diet because of celiac disease need to take extra care to make sure that no cross contamination occurs.  Cooking utensils, food storage containers, toasters, and cutting boards cannot be shared with foods containing gluten.  Additionally, gluten-free dieters need to be cautious of other items potentially containing gluten: energy bars, processed lunch meat, candy, condiments, communion wafers, beer, medicines, vitamins, lip balms, play dough (only affects the person if ingested), and the glue on stamps and envelopes. 

Scientists are investigating a variety of treatments for celiac disease.  Some are looking at trying to treat the immune system or the small intestine.  Food scientists are attempting to remove gluten from wheat.  Some people have suggested that fecal transplants might help, but to date, there is no research or study into this solution.  

Celiac disease can be a sneaky disease camouflaged by a variety of symptoms.  After the diagnosis though, a gluten-free diet will provide a relatively normal life.


References Cited

[1]      “Myths about Coeliac Disease.” Coeliac UK. Coeliac UK. Web. 21 Apr. 2017.

[2]     “What Is Celiac Disease?” WebMD. WebMD. Web. 21 Apr. 2017.


 

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