GastroEast Physicians, Louisville, KY

Celiac Disease

Celiac Disease or Celiac Sprue is a condition in which the lining of the small intestine is abnormal but improves after gluten is taken out of pix 1 one's diet. Celiac Disease affects men and women and people of all ages.

The small intestine is responsible for absorbing food and nutrients. Thus damage to the small intestinal lining that occurs in Celiac Disease, results in poor absorption of nutrients, a disease referred to as Malabsorption. The associated signs and symptoms vary from person to person. Some may have weight loss, diarrhea, abdominal pain, and other signs and symptoms due to a lack of vitamins and minerals, which are lost due to poor absorption in the small intestine because of Sprue. Others may have signs or symptoms of other diseases that are associated with Celiac Disease. These include hypothyroidism, hepatic or liver disease, diabetes mellitus, microscopic colitis, and weakness.

Celiac Disease is caused by a response to dietary gluten (rye, barley, and wheat). The mechanisms that cause this response are now just being discovered.

Celiac Disease may be suspected in patients with blood abnormalities pointing to the diagnosis. Certain antibodies present in Celiac Sprue can be detected in the blood which point to a diagnosis of Celiac Disease. These blood tests can be ordered by your gastroenterologist and may help point to the diagnosis. But, Celiac Disease should only be definitively diagnosed after EGD with direct visualization of the small intestine and with biopsies of the lining of the small intestine.

The lining of the small intestine usually takes on a scalloped appearance in Celiac Disease, and the biopsies show the characteristic destruction of the villi or nutrient absorbing microscopic projections or "fingers" that line the small intestine. If this destruction is seen, the patient can be diagnosed with Celiac Sprue.

Treatment
Treating Celiac Disease is eliminating gluten from the diet, which allows the finger like villi to grow back in the small intestine. Eliminating gluten from the diet requires a nutritionist consult for patient education. Once this consultation has occurred, the patient must make major lifestyle modifications to eliminate all wheat, rye and barley form the diet. Many prepared foods contain gluten and these foods must be eliminated also.

Fortunately, life on a gluten free-diet has become increasingly easier with gluten-free foods. Gluten-free substitutes -- for traditional gluten-containing foods -- are now available, which are safe and palatable

Many patients who adopt a gluten free diet have complete alleviation of symptoms, resolve any nutritional deficiencies and go on to lead normal lives. The response to a gluten free diet is often dramatic, with patients becoming symptom free in 1-2 weeks.

The most common reason for failure to respond is consumption of gluten foods inadvertently or by accident. Celiac Disease does run in families, and screening for Celiac Disease in asymptomatic family members may be considered after consultation with your gastroenterologist.