Celiac Disease
(Gluten Intolerance · Celiac Sprue)
In this condition factsheet:
The Facts on Celiac Disease
Celiac disease is also called celiac sprue, non-tropical sprue, and gluten-sensitive enteropathy. It is a hereditary autoimmune condition in which a person has a delayed immune reaction to gluten (a protein that causes dough to be sticky) found in cereals, such as wheat, barley, and rye. This reaction causes the immune system to attack the lining of the small intestine, damaging it so that it can't absorb nutrients from food.
Celiac disease affects almost 1% of people in Canada. Recent research has revealed that, contrary to what was previously believed, celiac disease may be just as common in places like Africa, South America, and Asia. The disease affects 10% of first-degree relatives and is about twice as common in women as in men.
Causes of Celiac Disease
The lining of a normal small intestine is covered with finger-like projections called villi. The villi are covered with tiny hair-like endings called microvilli, which trap and absorb nutrients from food. In celiac disease, the villi flatten out or disappear due to the immune reaction caused by eating foods that contain gluten. The villi lose their shape and their microvilli, resulting in the damage to the intestinal lining.
Although it was once thought of as a condition that always started in childhood, it is now known that celiac disease can develop at any age in susceptible individuals. You are more susceptible if you have a family history of celiac disease, have type 1 diabetes, or if you have other autoimmune conditions such as thyroiditis. There is a strong association between Down syndrome and celiac disease. In older people, celiac disease can be triggered by an intestinal infection or some other intestinal condition.
Symptoms and Complications of Celiac Disease
A person with celiac disease isn't able to absorb the nutrients from food. This problem of malabsorption can cause vitamin and mineral deficiencies. Iron deficiency from malabsorption causes anemia, which is a reduction in red blood cells. This can lead to fatigue and tiredness. Symptoms of celiac disease can include serious diarrhea, bloating, and cramps.
The food that isn't absorbed is excreted in feces. Too much diarrhea can lead to severe dehydration. Bowel movements are often bulky, light tan or grey, and frothy or rancid-smelling because the stools contain fat that couldn't be absorbed. The feces often stick to the toilet bowl because of the large amount of fat in them.
People with celiac disease often lose weight because their bodies can't absorb the much-needed nutrients from the foods they eat. Lack of vitamins and minerals may lead to many different complications. People who lack protein will have swollen legs. Lack of vitamin K causes bleeding gums. Some people's nerves will be affected and they may have trouble thinking or concentrating. Others may have dry skin or sore lips and tongue. Sometimes, people with celiac disease have osteomalacia (softening of bones) due to nutritional deficiencies. About 10% of people with celiac disease will develop an itchy rash that affects the knees, buttocks, elbows, shoulders, and scalp.
As a result of modern testing procedures (see "Making the Diagnosis"), we now know that some people with celiac disease may not have the typical intestinal symptoms that doctors used to think were required to make the diagnosis of celiac disease. If you experience certain more general symptoms such as anemia, abnormal liver function, or arthritis, your doctor may recommend that you get tested for celiac disease. Infertility can also occur if you have celiac disease.
