WHAT IS CELIAC DISEASE
Article Updated on 25 July 2021
Celiac disease is an autoimmune disease in which the body’s immune system becomes abnormally triggered by gluten-containing foods causing long-term symptoms like bloating, abdominal pain, diarrhea or constipation, among others.
Gluten is a naturally occurring protein found in some grains like wheat, barley, and rye. Bread, pasta, cakes, cookies, beer, and many other foods contain gluten, and can therefore trigger symptoms in people with celiac disease.
Celiac disease is the most severe form of gluten intolerance. Another, less severe, form of gluten intolerance is gluten sensitivity, also known as non-coeliac gluten sensitivity (NCGS). In contrast to celiac disease, NCGS causes milder symptoms, and the exact biology behind it is not well understood by doctors. There’s no test to diagnose NCGS and it’s usually diagnosed in people whose symptoms are clearly triggered by gluten, yet test negative for celiac disease.
Sprue, non-tropical sprue, and gluten sensitivity enteropathy are other names used to call celiac disease.
What is celiac disease?
Celiac disease is an autoimmune disease that is triggered by eating foods containing gluten. When a person who has celiac disease eats gluten-containing foods, immune cells mistake gluten for a foreign invader, and an immune reaction is initiated in the guts. The immune cells will release toxins that destroy the villi in your intestines. Villi are finger-like projections in the wall of our intestines that play an essential role in absorbing nutrients. The destruction of villi is a pathological hallmark of celiac disease.
Celiac disease affects around 1 in every 100 individuals worldwide, so it’s not a very rare disease.
What are the symptoms of celiac disease?
The symptoms of celiac disease can be digestive and non-digestive. In children, digestive symptoms are more prominent than in adults. The symptoms of celiac disease can vary from one person to another, where some people might experience none at all, while others experience persistent discomfort.
Digestive symptoms, mostly seen in children, include:
- Weight loss
- Nausea and vomiting
- Constipation or diarrhea
- Bloating and flatulence
- Belly pain
- Oily and very odorous and pale stools
Non-digestive symptoms are more commonly seen in adult patients with celiac disease, and they’re usually a result of prolonged gut inflammation which can lead to malnutrition and vitamin or mineral deficiencies. Non-digestive symptoms and signs include:
- Iron deficiency anemia
- Painful and stiff joints
- Tingling in the hands or feet (neuropathy)
- Bone weakness
- Certain skin conditions (like dermatitis herpetiformis)
- Discoloration of the teeth
- Loss of the enamel
- Period irregularities
- Persistent fatigue
The severity of symptoms depends on many factors, such as the age when a person was first fed gluten, how long they were breastfed as an infant, and the amount of gluten they currently consume. In certain individuals, symptoms may be minimal, however, the ill effects of malnutrition can manifest in one or more of the associated disorders like anemia and neuropathy.
Who usually gets celiac disease?
People who have a relative with celiac disease are more likely to have celiac disease. This has lead doctors to conclude that celiac disease has a hereditary component. Certain genetic and autoimmune conditions have also been associated with celiac disease:
- Diabetes Mellitus type 1
- Rheumatoid arthritis
- Lupus
- Thyroid disease
- Sjogren syndrome
- Down and turner syndromes
- Addison disease
How do doctors diagnose celiac disease?
Your doctor will start by asking you about your medical history, family history, and lifestyle habits. He or she will then ask you more specific questions about your symptoms, their frequency, your bowel habits, and your diet. If they suspect that you might have celiac disease, your doctor will order some tests:
- Antiendomysium (EMA) and anti-tissue transglutaminase (tTGA) antibodies: These are autoimmune antibodies that are characteristically high in people with celiac disease.
- Extended blood work: This might include a complete blood count, liver function tests, lipid panel, and albumin level. These give your doctor an idea about your nutritional status and help rule out other conditions that might be causing your symptoms.
- Skin biopsy: A doctor will remove a small piece of skin and send it to the lab to do some testing. Skin biopsies can be diagnostic for celiac disease and can eliminate the need for an intestinal biopsy.
- Intestinal biopsy: If blood tests and a skin biopsy are not diagnostic of celiac disease and your doctor still suspects it, an intestinal biopsy might be needed. This is done by upper endoscopy, which means that the doctor inserts a cord-like device (called endoscope) with a camera on its tip through your mouth and advances it to reach your intestines to take a biopsy. The procedure is done at the hospital and you will be sedated. An intestinal biopsy shows atrophy of the intestinal villi in patients with celiac disease.
What are the treatment options for celiac disease?
The only definite way to treat celiac disease is by following a gluten-free diet. When you eliminate gluten from your diet, the inflammatory process will cease, and your intestinal villi will heal. They will restore their absorptive function and the symptoms will improve. You can start improving as soon as a few days pass after you eliminate gluten from your diet.
A nutritionist will instruct you on what foods you will need to avoid. You will need to pick your groceries carefully to make sure that the products you’re buying are gluten-free. Most food producers clearly label their foods as “gluten-free” if they are. Make sure to clearly read the label when doing your shopping.
Living with celiac disease can sound exhausting since you’ll need to cherry-pick your foods to make sure you can eat them without triggering celiac symptoms. Nevertheless, people with celiac disease quickly adapt, especially with the booming gluten-free food industry.
Future Therapies
The ultimate goal of celiac disease research is to find a way to treat the disease without having patients follow a strict diet for the rest of their lives. This is why researchers all around the globe are working on different medications and vaccines to treat and prevent celiac disease. Here is a couple that holds some promise in healing celiac disease in the future:
- Celiac Vaccine TAK-101 (formerly known as CNP-101 and TIMP-GLIA): This vaccine for celiac disease has shown some promise in curing sprue in animal models. The drug is a nanoparticle vaccine that works by teaching the immune system that gluten particles are not the enemy. This is called “induction of immune tolerance”. The celiac disease vaccine was developed by Cour Pharmaceuticals, and the company is planning a human trial soon to test it.
- ZED1227: This is a new and promising oral drug to treat celiac disease. It works by inhibiting an enzyme called transglutaminase-2, which prevents damage to the intestinal mucosa. A new human trial is currently underway and early results seem to be promising.
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Sources:
- https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease?dkrd=hispf0095
- https://www.uptodate.com/contents/diagnosis-of-celiac-disease-in-adults
- https://www.uptodate.com/contents/management-of-celiac-disease-in-adults
- https://www.uptodate.com/contents/epidemiology-pathogenesis-and-clinical-manifestations-of-celiac-disease-in-children
- ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
- https://rally.partners.org/study/timp_glia
- https://www.celiac.com/articles.html/researchers-test-zed1227-oral-transglutaminase-2-inhibitor-for-celiac-disease-treatment-r5588/
- https://www.nejm.org/doi/full/10.1056/NEJMoa2032441
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