Celiac disease is also known as gluten sensitive enteropathy, or sprue. It is an autoimmune impairment of the digestive system which results in the intestines being unable to process and digest gluten. As a result, the individuals suffering from Celiac disease are allergic to wheat, rye and barley. It is one of the more prominent diseases of current times, with increased awareness about gluten sensitivity coming to light.
A classic patient with Celiac disease will present as complaining of ongoing loose stool, mostly unformed, fatty and foul smelling, along with flatulence, sensation of indigestion and borborygmus (loud intestinal sounds) due to excessive gas production in the intestines. Associated weakness, fatigue and lethargy are usually secondary to ongoing nutritional deficiencies in diet. it will generally result in significant weight loss, sometimes going up to > 45% body weight. Mild cramping along with bloating is common; however, severe abdominal pain is generally not a consequence of uncomplicated Celiac Disease.
Celiac disease manifests as intra-intestinal, as well as extra-intestinal symptoms.
Intra intestinal symptoms generally present as diarrhea, audible, uncomfortable stomach sounds, flatulence and indigestion. a good proportion of patients suffering from celiac disease may present with weight loss along with the above symptoms, as they are unable to process a majority of complex carbohydrates, which is one of the three major classes of food derived energy source.
Apart from intestinal symptoms, patients may also complain of weakness due to anemia, weak bones (osteopenia) skin disorders particular for celiac, such as dermatitis herpatiformis (pruritic, vesicular lesions mostly on neck, arms and buttocks).
Patients may also present with poor Vitamin K absorption (it is absorbed in the gut) resulting in bleeding disorders.
Physical signs in a typical patient with Celiac disease are usually:
peripheral edema (swelling of limbs, especially in the lower extremities)
signs of weight loss
ecchymoses and skin rash
In extreme cases, a patient may also present with neurological signs.
Other diagnoses which may have similar presentation to Celiac Disease include but are not limited to:
Iron Deficiency Anemia
Irritable Bowel Syndrome
Non Hodgkins Lymphoma
Inflammatory Bowel Disease
Before a diagnosis of Celiac Disease is made, patients should undergo diagnostic antibody testing ( IgA TTG ) and biopsies from the large intestine. Patients should also undergo other tests to rule out nutrient deficiencies secondary to Celiac.
Primary goal of management is control of symptoms are reduction of possible complications down the road from nutrient deficiency. The first and most important step in management of Celiac is gluten free diet for the patient. If, despite negative testing patient is highly likely to have Celiac disease, he should be started on a gluten free diet and observed for improvement in symptoms. The following grains are the most common sources of gluten:
- Wheat germ
- Gram flour
For patients who do not respond to dietary restriction/elimination of gluten, a trial of steroids maybe given.
Patients with Celiac also benefit from a detailed consultation with a dietician.