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Celiac Disease

DEFINITION

Celiac disease or celiac sprue is the medical name for allergy to gluten, a protein found in many foods including breads, baked goods, pastas and foods made of wheat, barley or rye. It goes by many names including celiac sprue, gluten intolerance, and gluten sensitive enteropathy. Normally, gluten is broken down and digested in the small intestine at tiny finger-like projections from the wall called villi. These microscopic villi are also responsible for absorbing other nutrients, vitamins, and minerals. In celiac disease, your body has an immune reaction or an allergy to the gluten. This allergic reaction causes inflammation of and damage to the villi which leads to poor absorption of nutrients. Resultant vitamin deficiencies can become quite serious and affect many parts of the body including the liver, muscles, nerves and brain. The symptoms caused by celiac disease include diarrhea, abdominal pain and cramping, and weight loss or poor growth. Nobody knows why celiac disease happens, but it often runs in families. Sometimes, the symptoms of the disease arise for the first time after a severe stress like injury, pregnancy or infection. Risk factors for having celiac disease include: autoimmune diseases like Type 1 diabetes and thyroid disease, down syndrome, and microscopic colitis. Possible complications include malnutrition, anemia, weight loss, loss of calcium, decrease in bone density, lactose intolerance (sensitivity to the sugar found in milk), neurologic problems like seizures or peripheral neuropathy, and certain types of cancer of the bowels.

SYMPTOMS
Diarrhea, abdominal cramping, abdominal pain, bloating and gas, anemia, joint pain, muscle cramps, rash, irritability, anemia, sores in the mouth, osteoporosis, tingling in the legs and feet, weight loss, fatigue, foul-smelling stool

DIAGNOSIS
Your doctor will begin by talking about your symptoms and doing a physical exam, especially focused on the abdomen and skin. Your doctor may recommend trying to cut gluten out of your diet to see if your diarrhea improves. Your doctor may also recommend blood tests which can test for the disease itself as well as blood counts and nutritional deficiencies. You may see a gastroenterologist for special testing including an upper endscopy which involves placing a thin tube with a camera on the end down the throat into the stomach and upper part of the small intestine. The gastroenterologist may want to take a small piece of the small intestine (biopsy) to look at under a microscope to look for signs of damage like shortening and flattening of the villi.

TREATMENT
No cure is available for celiac disease but, fortunately, the symptoms can be controlled by changing your diet. You will need to look for gluten free foods to make up your diet. You won’t be able to eat foods containing wheat, barley or rye. You should avoid foods containing the following ingredients: farina, graham flour, durum, semolina, rye, bulgur, barley, kasha, kamut, matzo meal, triticale and spelt. Most importantly, you will need o look for foods that say “gluten-free” on the package because they will be processed in facilities where they do not interact with gluten containing products. Once you stop eating gluten, the inflammation in the small intestine will begin to subside. Complete healing of the small intestine may take two to three years. Your doctor may recommend vitamin and mineral supplements in order to replace items you may be missing. Meeting with a dietician may help your create a diet balanced in proteins, grains, dairy products, vegetables and fruits. If dietary changes don’t work, you should talk to your doctor or gastroenterologist about other treatment options. You should talk to your doctor about your treatment options.

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