Celiac disease (CD), also called common sprue or gluten-sensitive enteropathy), is an autoimmune disorder that involves a heightened immunological response to ingested gluten in genetically susceptible people. It was believed to be uncommon but population based studies show that it is much more prevalent than previously thought.
In celiac disease, the immune system in a person’s intestine reacts to a protein called gluten. Gluten naturally occurs in wheat, barely, and rye. The immune reaction makes part of the gut inflamed, which can make it difficult for the person to absorb nutrients from their food.
Celiac disease can cause a wide range of symptoms in the digestive system (such as indigestion, diarrhoea, or constipation) and the rest of the body (such as tiredness, weight loss and bone thinning). Symptoms may be similar to those in other conditions, such as irritable bowel syndrome, IBS (see the references below and: Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis in the Arch Intern Med. 2009). Some people with celiac disease have no symptoms at all.
Celiac disease is believed to be present in up to 1 to 100 of the population, although only about 10-15% of people with the condition are clinically diagnosed. Many of the remainder may be well, but many will have chronic problems such as lethargy or gastrointestinal symptoms. These can result in chronic ill health and long term complications including osteoporosis and increased fracture risk. In children, growth failure, delayed puberty and dental problems can be the serious consequences.
People with celiac disease carry higher than normal levels of certain antibodies, such as anti-gliadin, anti-endomysium (AEA or EMA) and anti-tissue transglutaminase (anti-tTG). Patients showing the following signs and symptoms or conditions may be at higher risk of celiac disease.
Signs and symptoms of celiac disease:
- chronic or intermittent diarrhoea
- failure to thrive or faltering growth (in children)
- persistent or unexplained gastrointestinal symptoms including nausea and vomiting
- prolonged fatigue
- recurrent abdominal pain, cramping or distension
- sudden or unexplained weight loss
- unexplained iron-deficiency anaemia
Conditions for celiac disease:
- type 1 diabetes
- autoimmune thyroid disease
- dermatitis herpetiformis
- irritable bowel syndrome, IBS
- anaemia without an obvious cause
- certain symptoms related to the digestive system, such as frequent diarrhoea, abdominal pain or vomiting, nausea or sudden weight loss
- close relatives (parents, children or brothers and sisters) with celiac disease
Once celiac disease has been diagnosed, the treatment is a strict gluten-free diet. However, a blood test and intestinal biopsy will show celiac disease only if the person being tested is eating gluten regularly.
Here you will find a NICE guideline to improve the recognition and assessment of celiac disease, issued 27/05/2009 (accessed 02/08/2010 – NICE stands for the National Institute for Health and Clinical Excellence). Additionlly, NICE had published “Do not do recommendations” on serological testing, released May 2009 (accessed 02/08/2010).
For patients, their families and carers and for everyone interested in the condition the National Institute for Health and Clinical Excellence (NICE) have published a booklet about signs and symptoms of celiac disease, which is to help understand how the disorder should be diagnosed: Coeliac disease: recognition and assessment of coeliac disease.
In addition, you will find a comprehensive list of recommended reading about celiac disease and serological testing for anti-tTG, endomysial antibodies, anti-gliadin and on the new anti-DGP tests (anti-DGP stands for antibodies against deamidated gliadin proteins) on the ORGENTEC Diagnostika Homepage: Celiac Disease / Celiac Sprue – Serological Testing: Anti-tTG, Endomysial Antibodies (EMA), Anti-Gliadin, Anti-DGP
Barker JM, Liu E. Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr. 2008;55:349-65. Review. – free full text article
Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009 Apr 13;169(7):651-8. Review. – free full text
Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, Zinsmeister AR, Melton LJ 3rd, Murray JA. Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology. 2009 Jul;137(1):88-93. Review. – free full text
Rubio-Tapia A, Murray JA. Celiac disease. Curr Opin Gastroenterol. 2010 Mar;26(2):116-22. Review. – abstract
Schuppan D, Junker Y, Barisani D. Celiac disease: from pathogenesis to novel therapies. Gastroenterology. 2009 Dec;137(6):1912-33. – free full text
van Heel DA, West J. Recent advances in coeliac disease. Gut 2006;55:1037-1046. Review – free full text
Additional Internet resources:
- The website of the Celiac Disease Foundation, CDF, in California, USA
- The Mayo Clinic website on celiac disease, its definition, symptoms, causes, tests and diagnosis
- Healthcare professionals FAQs on celiac disease on www.coeliac.org.uk
- Celiac disease on familydoctor.org, a website of the American Academy of Family Physicians: What is celiac disease? How can I control celiac disease?