Celiac Sprue (Gluten Allergy)
Celiac disease (CD) is thought to affect approximately 3 million people in the US and perhaps 35% of the population carry a gene that is associated with this condition. CD is characterized by abdominal bloating, diarrhea, IBS and over time can lead to weight loss and malnutrition. The cause of celiac appears to be an abnormal food allergy to wheat, barley and rye and specifically gliadin which is a molecule found in these foods.
The normal intestinal system has immune cells within the lining that are always ready to fight off infections, however in celiac patients there is an abnormal reaction to gliadin. The intestines become inflamed due to repeated exposure to gliadin and eventually lead to scarring and injury to the absorptive cells within the lining. Over many years, the damage can become so severe that the small intestines can no longer absorb and process food normally resulting in malabsorption which leads to weight loss, increased diarrhea and nutrient deficiencies. There is a genetic predisposition for this condition. Specifically a mutation in HLA DQ2 and DQ8 and chromosome 15q26 and 5s.
There are blood markers that may be elevated in patients with celiac. A study form northern Italy following over four thousand individuals with celiac found that IgA antiendomysium may be the most reliable antibody marker for identifying affected individuals, but other useful markers include IgG antiagliadin and IgA antigliadin. Antibodies to tissue transglutaminase are also useful.
Patients with abnormal antibody testing or symptoms suspicious for celiac disease should have upper endoscopy to directly visualize the upper intestinal lining. During the endoscopy, small samples of the lining are taken and sent to a laboratory for further study. The pathologist will look at the small intestinal samples and can confirm the diagnosis of celiac disease.
How is Celiac Disease Treated?
The good news is that celiac disease is very treatable and symptoms can usually be eliminated. The bad news is that it requires a major change in diet that must be maintained for the rest of your life. To make this a little more challenging, compliance with the diet needs to be almost 100 % in order to effectively control CD. Partial compliance won't do it. Once a diagnosis has been confirmed through blood work and endoscopic biopsy of the small bowel, we recommend consultation with a qualified dietitian to provide guidance during the change to a gluten free diet.
Patients are seen regularly in our office to confirm celiac is well controlled and to have testing for any issues that may be caused by this condition.. Support groups are important with this condition as people share tips on diet and ways to manage this condition.