Celiac Disease

A reader wants to know about celiac disease. Celiac disease is also known as celiac sprue.

Celiac means abdominal cavity. Celiac disease mainly affects the small intestine which is in the abdominal cavity. Very rarely it can affect stomach, colon or rectum.

Sprue is a chronic disorder that occurs in tropical and nontropical forms. It can affect children and adults. It is a condition in which nutrients are not absorbed. Symptoms of sprue include foul-smelling diarrhea and loss of weight.

Celiac sprue is due to gluten sensitivity of the small intestine. Gluten is a mixture of plant proteins occurring in cereal grains, chiefly corn and wheat, used as an adhesive and as a flour substitute. Gluten is a complex and variable mixture of glutin or gliadin, vegetable fibrin, vegetable casein, oily material, and others.

Gliadin is any of several simple proteins derived from rye or wheat gluten. It is capable of inducing a toxic response among individuals who lack the enzyme necessary for its digestion. Gliadin is vegetable glue or gelatin

Celiac sprue has been described since the first century A.D. But it was in 1940s, when a link to gluten was established by a Dutch pediatrician. He observed that children with celiac disease improved during the food shortages of the World War ll. But the symptoms recurred when the cereal supplies were restored, says an article in the New England Journal of Medicine (NEJM).

Symptoms of celiac sprue in children appear when cereal is introduced in their diet, anywhere between the ages of four to 24 months. They present with diarrhea, impaired growth and abdominal distension. Vomiting, anemia and swelling of the body tissues with fluid occur due to malnutrition.

Celiac sprue can develop in adults as new cases. The NEJM article says that 20 per cent of the patients may be diagnosed after the age of 60. Otherwise, most adults with celiac disease will have history of the disease going back to childhood.

NEJM article says that iron-deficiency anemia is now the most common clinical presentation in adults with celiac sprue. And approximately 50 per cent of adult patients do not have clinically significant diarrhea.

There are several immunological blood tests available to make a diagnosis of celiac disease. But the only confirmatory test is small bowel biopsy. Usually from second or third part of the duodenum during gastroscopy.

A person should not be prescribed gluten free diet until the biopsy has confirmed the diagnoses. Abnormality in small bowel disappears once the person strictly follows gluten free diet. So biopsy first is mandatory.

What are the dietary guidelines for patients with celiac disease? The NEJM article advises as follows:

1. Avoid all foods containing wheat, rye, and barley gluten.
2. Avoid all foods containing oats and lactose (at least initially).
3. Use only rice, corn, maize, buckwheat, potato, soybean, or tapioca flours, meals or starches.
4. Look for foods that have the gluten-free symbol.
5. Try foods containing wheat starch from which gluten has been removed.
6. Read all labels and study the ingredients of processed foods.
7. Beware of gluten in medications, food additives, emulsifiers, and stabilizers.
8. Avoid all beers, lager, ales, and stouts.
9. Wine, liqueurs, most ciders, and other spirits, including whiskey and brandy, are allowed.
10. Take essential medications through other routes than mouth if malabsorption is severe.

Once celiac is diagnosed, it is prudent to stay on a life-long gluten-free diet. It is not easy but the alternatives are worse – development of cancer of the small bowel and other complications related malnutrition.

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