Celiac Disease Symptoms, Diagnosis, And Treatment

Celiac disease, or celiac sprue, or gluten-sensitivity, is a disorder that is triggered by the consumption of gluten. Often, celiac disease symptoms may be confused with those of gluten intolerance. However, an important difference between the two is the intestinal damage caused when a person is suffering from celiac disease.

What is Celiac Disease?

Celiac disease is a digestive disorder. Although it is an autoimmune disease triggered by an abnormal immune response to gluten, it is more than simple gluten intolerance. When a person with celiac disease ingests gluten, an abnormal immune response is triggered which damages the intestinal villi; small finger-like projections that are present inside the inner lining of the small intestines as it is an immune-mediated disorder. Villi are responsible for absorption of nutrients from food, the damage caused results in the non-absorption of these essential nutrients from the ingested food, leading to malnutrition and serious medical complications. At its worst, it may lead to total and irreversible intestinal damage. Affecting both children and adults alike, celiac disease symptoms are different across the spectrum. 

Surprisingly, some affected may experience no symptoms at all. But unfortunately, the intestinal damage continues. Thus, a comprehensive understanding of celiac disease symptoms, its proper diagnosis, and treatment becomes important.

Types of Celiac Diseases

The World Gastroenterology Organization has categorised celiac disease into two types:

• Classical Celiac Disease: Patients suffering from celiac disease fall under the classical type if they experience and exhibit signs and symptoms of mal-absorption.
• Non-Classical Celiac Disease: Patients suffering from celiac disease fall under the non-classical category if they experience mild gastrointestinal symptoms with no clear indication of mal-absorption. 

Celiac Disease Symptoms in Adults

Adults experience digestive symptoms like:

1. Constipation
2. Diarrhoea
3. Gas
4. Bloating

As long-drawn celiac disease damages the inner lining of the small intestines and impairs its ability to absorb nutrition from food, several health conditions may surface. These include:

1. Iron-deficiency anaemia 
2. Fatigue 
3. Bone or joint pain  
4. Osteoporosis or loss of bone density 
5. Osteomalacia or the softening of bone 
6. Arthritis
7. Infertility 
8. Recurrent miscarriage
9. Irregular or missed menstrual periods
10. Depression 
11. Anxiety attacks
12. Peripheral neuropathy i.e. tingling, numbness, or pain in the hands and feet
13. Seizures or migraine attacks
14. Liver and biliary tract disorders like transaminitis, primary sclerosing cholangitis, fatty liver, etc.
15. Mouth ulcers or canker sores inside the mouth
16. Dermatitis herpetiformis or itchy skin rashes

Celiac Disease Symptoms in Children

Children suffering from celiac disease experience digestive problems. These include:

1. Vomiting
2. Nausea
3. Abdominal pain
4. Abdominal bloating
5. Gas
6. Persistent constipation or diarrhoea 
7. Foul-smelling, pale, and fatty stools

Mal-absorption of nutrients may cause:

1. Iron-deficiency anaemia
2. Weight loss
3. Fatigue
4. Irritability
5. Behavioural issues
6. Dental enamel defects 
7. Impaired growth and delayed puberty
8. Short stature
9. Attention Deficit Hyperactivity Disorder (ADHD)
10. Learning disabilities
11. Lack of hand-eye coordination
12. Seizures

Who Should Get Tested?

Individuals facing celiac disease symptoms should get tested for the same. You should also be wary of the following points:

1. Children aged 3 and above with symptoms of celiac disease must get screened and tested for the ailment.
2. In case of parents, siblings, or children who have contracted celiac disease, the individual must get the test done. In cases where the first-relation relatives have celiac disease, the risk of contracting it increases manifold.
3. If the individual has any other underlying autoimmune medical condition, it is advisable to get tested for celiac disease.

Diagnosis of Celiac Disease

Physical examination and thorough medical history, both go hand-in-hand for celiac disease diagnosis. There are a series of blood-based tests that help diagnose celiac disease. The physician will put you on a gluten diet to get accurate results. The medical tests include:

• tTG-IgA Test: A tissue transglutaminase IgA test is a blood test for celiac disease that helps determine the presence of antibodies (immunoglobulins) in the body.

• IgA Endomysial antibody (EMA): EMA is a more specific test for celiac disease. The use of primate oesophagus or human umbilical cord is required for this test. It is expensive but is most suitable for patients wherein diagnosis is difficult. 
• Total serum IgA: The Total serum IgA provides a reading of IgA levels in the blood. A deficiency is indicative of celiac disease and may necessitate the need for further testing.
• Deamidated gliadin peptide (DGP IgA and IgG): This test is usually done on people who have low IgA levels. It is also recommended for people who tested negative for tTg or EMA antibodies but continue to have symptoms of celiac disease. 
• Video capsule endoscopy (VCE): Video capsule endoscopy helps detect macroscopic atrophies of the small bowel. It includes sending a small video capsule into the gastrointestinal (GI) tract to get images of the condition of the inner lining of the small intestines.
• Intestinal fatty acid-binding protein (I-FABP): A blood-based test that helps pick up levels of cytosolic protein which is released in the bloodstream when cellular damage occurs. 
• Radiology: Few radiological tests which measure the small-bowel dilation, wall thickening, vascular changes, etc. may indicate the presence of celiac disease. But radiological tests alone might not give foolproof results. 

Celiac Disease Treatment

Celiac disease is a lifelong ailment with no cure. While celiac disease treatment is not possible, there are remedies to manage and reduce the effects of symptoms of the disease. Switching to a gluten-free diet is also a remedy. Thankfully, they work well for all patients as they improve the quality of life significantly. Also, celiac disease symptoms begin to improve gradually once gluten is removed from the diet. Furthermore, with time, the intestinal villi begin to heal and slowly start absorbing nutrients effectively. But it is important not to avoid gluten until a diagnosis is made. Removing gluten before proper diagnosis can interfere with test results, leading to inaccurate diagnosis.

Foods to Eat in Celiac Disease

Even if you are on a gluten-free diet, there is a range of foods that you can splurge on. A gluten-free, celiac disease diet may include:

1. Meat, poultry, and seafood
2. Eggs
3. Dairy products
4. Healthy fats
5. Fruits and veggies
6. Nuts
7. Gluten-free grains like quinoa, rice, buckwheat, and millets
8. Legumes
9. Herbs and spices

Foods to Avoid in Celiac Disease

There are cases where foods that contain gluten but the same may not be mentioned on the product label. In order to avoid celiac disease symptoms, you should avoid the following foods if they are not specifically labelled as gluten-free:

1. Pasta and bread
2. Cakes and cookies
3. Pies
4. Crackers
5. Beer
6. Salad dressings, sauces, and gravies
7. Foodgrains like wheat, barley, rye, etc.
8. Semolina
9. Oats / gram flour processed at facilities  where wheat, rye is also processed, otherwise, pure oats and gram flour are gluten free

Complications of Untreated Celiac Disease

Celiac disease is a serious medical condition. If left undiagnosed and untreated, it may cause serious health complications like:

1. Malnutrition: As the small intestines fail to absorb nutrients from food, conditions like iron deficiency, weight loss, impaired growth may surface.
2. Weakening of Bones: Under absorption of calcium and vitamin D leads to softening of bones in children and a loss of bone density in adults.
3. Infertility and miscarriage: Low nutrient absorption by the small intestines can contribute to reproductive issues.
4. Cancer: People with celiac disease who fail to switch to a gluten-free diet are at a higher risk of developing intestinal lymphoma and cancer of the small bowel.
5. Nervous system problems: People with celiac disease are at risk of seizures and other nervous system disorders like peripheral neuropathy. 
6. Lactose intolerance: The damaged inner lining of the small intestine can make you lactose intolerant.

Therefore, early identification of celiac disease symptoms becomes important. It can help you avoid the above listed conditions, and get the required medical support on time.

Conclusion

Celiac disease is a rare autoimmune disorder that affects the gastrointestinal tract. While celiac disease symptoms may range from moderate to severe, it is a serious condition that can lead to total and permanent intestinal collapse. Thus, proper diagnosis and treatment are crucial for the management of celiac disease. If you experience symptoms similar to that of celiac disease or are a first-degree relative of someone diagnosed with celiac disease, talk to your doctor about getting tested. Even though celiac disease treatment does not exist, consuming a diet free of gluten can be helpful in managing the disease. While a gluten-free diet is the only remedy for managing celiac disease, it should not be started prematurely without accurate diagnosis.