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Celiac disease is a digestive disorder, where consumption of gluten produces an abnormal immune reaction in the gut and the body resulting in signs and symptoms in the abdomen and in other parts of the body like teeth, skin, etc. In this article, you will get to know about signs and symptoms of celiac disease, and all about causes of celiac disease here.
Celiac disease also leads to damage to the small intestine which may result in nutritional deficiencies.
Gluten is a type of protein found in cereals such as wheat, barley, and rye. Thus, it is present in common day to day food items like Rotis, bread, pasta, cakes, cookies, and others.
Apart from this, many processed food items (such as sauces, soups, salad dressings, etc), nutrient supplements, vitamins as well as daily-use items like lip balms, lipstick, toothpaste, skin, and hair products also contain gluten in it. Rarely, it can be also present in some medicines.
Celiac disease is different from gluten sensitivity or wheat intolerance where the person develops some complaints similar to the celiac disease on consuming gluten but doesn’t cause damage to the small intestine. Below we will talk about signs and symptoms of celiac disease, just read this content till the end.
Celiac disease is also different from wheat allergy where the person develops immune reaction against the wheat however, there are no long-standing damages to the small intestine as seen in celiac disease. Moreover, in wheat allergy, you may also develop allergy-like signs and symptoms of celiac disease such as itchy eyes and breathing difficulty not seen in celiac disease.
Wheat allergies also do not cause long-term damage to the small intestine.
It is found that about 1.4% of people in the world have high chances of having celiac disease (proven by blood tests) and 0.7% world population has proven disease (proved by biopsy). It is estimated to affect 1.2% population of north India with a decreasing trend in northeastern and southern India affecting about 0.9% and 0.1% individuals.
The number of individuals affected by the non-celiac gluten sensitivity is not known but is thought to be significantly higher. According to a few experts only about 5% of people with the condition are diagnosed, the rest of the 95% of people remain undiagnosed because of the its signs and symptoms of celiac disease.
Celiac disease is found in all parts of the world affecting children, adults, males and females and people from different backgrounds, but it is found to be more common in the following groups:
Family history: as the celiac disease runs in families, there is a higher chance of developing the disease, if someone in the family has it. Especially, if someone has a first degree relative like parents or siblings with the disease, they have 1 in 10 chances of having it too.
Race: more common in caucasian people
Sex: more common in females than males
Age: more common in children than adults
Auto-immune conditions: the disease is more commonly seen in auto-immune conditions like type 1 diabetes, autoimmune thyroid disease, Addison’s disease, and autoimmune hepatitis.
There are about 200 signs and symptoms of celiac disease, which can vary greatly but can be broadly categorized into digestive signs and symptoms of celiac disease and non-digestive signs and symptoms of celiac disease. The digestive signs and symptoms of celiac disease are more common in children whereas adults present more commonly with non-digestive symptoms.
Some people with celiac disease may not develop symptoms of celiac disease, until certain health issues such as infection, pregnancy, childbirth, surgery, or severe mental stress may trigger the onset of the signs and symptoms of celiac disease.
• Gas, bloating or swelling in the abdomen
• Chronic diarrhea
• Nausea and vomiting
• Pale, foul-smelling, or fatty stools that float on water
• Abdominal pain
• Damage to the enamel (covering) of teeth
• In infants, it can lead lead to failure to thrive
• Weight loss
• Short height and slow growth
• Delayed puberty
• Irritability, mood changes or being impatient
• ADHD, headache, seizures, etc.
• Anemia, commonly due to iron deficiency
• Reduction in bone density (osteoporosis) resulting in weak bones
• Bone and joint pains
• Missed periods in females
• Infertility or repeated abortions
• Skin problem with itchy skin rashes called Dermatitis herpetiformis
• Red and smooth tongue
• Mouth ulcers or dry mouth
• Tingling numbness in the hands and feet
• Anxiety or depression
• Abdominal pain
• Gas and bloating
• Stomach or intestinal ulcers
signs and Symptoms of celiac disease and gluten sensitivity are similar and may include: recurring abdominal pain, chronic diarrhea/constipation, tingling/numbness in hands and feet, chronic fatigue, joint pain, unexplained infertility and low bone density (osteopenia or osteoporosis). There are approximately 200 potential symptoms, many of which are also symptoms of other conditions.
If the celiac disease remains undiagnosed or untreated for a long time it can lead to complications or other autoimmune conditions in the body. The later the celiac disease is diagnosed, the more are the chances of developing complications and another autoimmune condition.
This is least at the age of 2-4 years, being about 10.5%, which increases with increasing age being 34% in people over 20 years of age.
These complications and their estimated prevalence in celiac disease are given below:
• Anemia 12-69%
• Autoimmune thyroid disease 26%
• Dermatitis herpetiformis 25%
• Lymphocytic colitis 15-27%
• Unexplained infertility 12%
• Peripheral neuropathy 10-12%
• Gluten ataxia 10-12%
• Liver disease 10%
• Type I diabetes 8-10%
• Malnutrition: this occurs due to damage and inability of the small intestine to absorb nutrients from food resulting in anemia and weight loss. In children, it may also lead to slow growth and short stature.
• Weakening of bones: due to decreased absorption of the calcium and vitamin D, there is the loss of density of bones in adults (osteopenia/ osteoporosis) and softening of the bones (osteomalacia or rickets) making them prone to fractures.
• Lactose intolerance: damage to the small intestine can also result in the inability to absorb lactose from milk and milk products resulting in lactose intolerance.
• Cancer: long-standing untreated celiac disease also increase the chances of development of small bowel cancer and intestinal lymphoma.
• Refractory celiac disease: rarely, the small intestine becomes severely damaged and is unable to recover even after starting a gluten-free diet resulting in refractory disease. These people are unable to absorb nutrients and thus a person is given nutrients through the intravenous line.
After the signs and symptoms of celiac disease you should also about its causes. Multiple studies have found a number of conditions that lead to the development of celiac disease in a person. These can be broadly categorized into three:
Genetic factor: celiac disease is almost always seen to develop in people carrying specific genes namely, HLA DQ2 and/or HLA DQ8. However, not all people with these genes develop the disease. About 1/3rd of the population carries these genes from which about 1-5% of the people develop celiac disease, indicating also the role of environmental factors in the development of the condition.
Gluten consumption: the disease has been found to be more common in the population with high gluten or wheat consumption. It is found to affect more people in north India which has higher wheat consumption than people in north-eastern and southern parts of India where there is a predominant rice-eating population.
Triggering factors: it is considered that an event or a trigger initiates the development of celiac disease in these patients. Several triggers have been identified such as an infection (viral, or bacterial), emotional stress, trauma, surgery, and more.
To come to diagnosis the doctor would start with taking a clinical history including family history. He may do a physical examination of the body, abdomen, and teeth. In case of suspicion of celiac disease, he would ask for some diagnostic tests like blood tests, genetic tests, and biopsy.
The only treatment of celiac disease is to remove gluten from the diet (known and unknown sources) and from other non-dietary sources that can go into the mouth and reach the intestine.
Typically, there is no medicine required, and consuming a gluten-free diet stops further damage to the small intestine and initiates healing and recovery.
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