Could your stomach problems be celiac disease?

Pinning down a diagnosis of celiac disease can be difficult because of the wide range of symptoms associated with this auto-immune digestive disease. For some people, the symptoms include abdominal pain and weight loss, for others irritability is the primary symptom. In children, failure to thrive is often the first suggestion that celiac disease is present. Some experience no symptoms at all.

“It was once believed that celiac disease was a relatively rare condition,” notes Dr. Miles J. Varn, Chief Medical Officer of PinnacleCare. “The data suggested that only about 1 in 5,000 Americans were affected by the disease. But today, celiac disease is the most commonly diagnosed autoimmune disease in this country, affecting one out of every 133 people. That is why it’s important for people to be aware of the symptoms and effects of the disease and seek medical advice to help ease symptoms and combat the sometime serious problems this digestive disorder can cause.”

What is celiac disease?

Celiac disease can also manifest as a skin condition known as dermatitis herpetiformis (DH). This itchy rash causes blisters, usually located on the elbows, knees and buttocks. A large portion of the people with this form of the disease do not have any digestive symptoms, but when their small intestine is examined, they do have the same type of damage to the villi caused by gluten.

A difficult diagnosis

Research by Dr. Peter Green, Director of the Celiac Disease Center at Columbia University Medical Center found that on average, it takes 11 years for a person with celiac disease to be accurately diagnosed. “The rate of diagnosis is much greater in other parts of the world, but even in those countries, the majority of people with the disease remain undiagnosed because celiac masquerades as many different medical problems,” Dr. Green says.

That lag in diagnosis can have serious health consequences. Not only are people with untreated celiac disease at risk for malnutrition, anemia and osteoporosis they are also at an increased risk for gastrointestinal cancers and developing a form of cancer called non-Hodgkin’s lymphoma.

A wide range of symptoms to watch for

• Recurring abdominal bloating and pain

• Chronic diarrhea/constipation

• Vomiting

• Liver and biliary tract disorders

• Weight loss

• Pale, foul-smelling stool

• Iron-deficiency anemia that does not respond to iron therapy

• Fatigue

• Failure to thrive or short stature in children

• Delayed puberty

• Pain in the joints

• Tingling numbness in the legs

• Pale sores inside the mouth

• Dermatitis herpetiformis (DH), a skin rash

• Tooth discoloration or loss of enamel

• Unexplained infertility and recurrent miscarriage

• Osteopenia (bone loss) or osteoporosis

• Pain, numbness, tingling in the hands and feet

• Psychiatric problems including anxiety and depression

Children are more likely to have digestive symptoms including diarrhea and/or constipation, bloating and stomach pain and growth and mood symptoms such as failure to thrive, fatigue and irritability. Adults, on the other hand, experience more wide-ranging symptoms. In fact, only about a third of adults diagnosed with celiac disease have persistent diarrhea. The most common symptom in adults is anemia that fails to respond to iron therapy. The process of diagnosing celiac disease begins with an antibody blood test that looks for high levels of the antibodies anti-endomysium and anti-tissue transglutaminase. If you have a high level of these proteins in your blood, an endoscopic biopsy of the small intestine will be performed to confirm the diagnosis by determining if there is damage to the villi. People with the form of celiac disease that causes a skin rash are diagnosed by a skin biopsy.

Early diagnosis and treatment can help prevent the development of other problems related to celiac disease and research has discovered that early intervention can lessen the likelihood that a child with celiac disease will develop another autoimmune condition. Children diagnosed between the ages of 4 and 12 have a 17 percent risk of developing an additional immune disorder. If they are diagnosed between the ages of 12 and 20, the risk rises to 27 percent. For those diagnosed after age 20, there is a 34 percent chance of developing another autoimmune disorder.

Gluten-free is the solution The only treatment for celiac disease is to follow a strict gluten-free diet. If you have the form of the disease that causes a skin rash, the rash can be controlled with the medications dapsone or sulfapyridine, but you still need to follow a gluten-free diet.

Learning what you can and cannot eat takes time because gluten pops up in unusual places. Not only is it in breads and baked goods, pastas and beer, you’ll also find gluten in candy, soy sauce, processed American cheese, mouthwash, vitamins, medicines, even communion wafers and the adhesives on stamps and envelopes. Working with a dietitian who specializes in celiac disease can help you learn how to read food labels to uncover hidden sources of gluten.

When a gluten-free diet is followed carefully, the damage to the intestine heals and future damage is prevented. It is essential, however, that gluten be strictly excluded from your diet, because eating even a small amount can trigger the recurrence of the disease and cause small intestine damage.

While eating a gluten-free diet can be challenging, more and more stores are offering a range of gluten-free products. Notes Anne Roland Lee, nutritionist at the Celiac Disease Center at Columbia University Medical Center, “The good thing is that it's easy to avoid gluten; a steak and potato dinner, for example, is gluten free. (Gluten-free) doesn't mean you can't go out and live, it just takes a little planning.”

PinnacleCare Members can work with their Advocate to find the top physicians and nutrition specialists in the field of celiac disease. They can also rely on their Advocate to provide them with the latest, scientifically objective information on the topic.

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