Hello tricot-ga!
Thank you once again for thinking of me with this question! I
appreciate the opportunity to help you out. I did some research and
have found answers to your questions. I added a little bit of an
overview as well in case that is useful to you. As a disclaimer, I?ve
been careful to include only high-quality sources for the information
contained in this answer, but my answer itself is in no way intended
to substitute for a professional medical opinion. Please be sure to
discuss any specific concerns you may have with a qualified medical
professional that you trust. With that said, here we go!
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BACKGROUND
The Mayo Clinic has a nice overview of Celiac Disease on its website.
?Celiac disease is a digestive condition triggered by consumption of
the protein gluten, which is found in bread, pasta, cookies, pizza
crust and other foods containing wheat, barley or rye. Oats may
contain gluten as well. When a person with celiac disease eats foods
containing gluten, an immune reaction occurs in the small intestine,
resulting in damage to the surface of the small intestine and an
inability to absorb certain nutrients from food.
Eventually, decreased absorption of nutrients (malabsorption) can
cause vitamin deficiencies that deprive your brain, peripheral nervous
system, bones, liver and other organs of vital nourishment, which can
lead to other illnesses. This is especially serious in children, who
need proper nutrition to develop and grow.
Also known as celiac sprue, nontropical sprue and gluten-sensitive
enteropathy, celiac disease occurs in people who have a susceptibility
to gluten intolerance. Some speculate that celiac disease has been
around since humankind switched from a foraging diet of meat and nuts
to a cultivated diet including grains such as wheat. Nonetheless, it
has only been in the last 50 years that researchers have gained a
better understanding of the condition and how to treat it.
No treatment can cure celiac disease. However, you can effectively
manage celiac disease through changing your diet.?
http://www.mayoclinic.com/health/celiac-disease/DS00319
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CAUSES OF CELIAC DISEASE
The following information about the causes of Celiac Disease comes
from the website of the Celiac Disease Foundation.
?The cause of Celiac Disease, also known as celiac sprue, or gluten
sensitive enteropathy (GSE), is unknown. Current research indicates
that CD is strongly associated with a group of genes on Chromosome 6.
These genes (HLA class II antigens) are involved in the regulation of
the body's immune response to the gluten protein fractions.
One out of 133 people in the United States is affected with celiac
disease. CD occurs in 5-15% of the offspring and siblings of a person
with celiac disease. In 70% of identical twin pairs, both twins have
the disease. It is strongly suggested that family members be tested,
even if asymptomatic. Family members who have an autoimmune disease
are at a 25% increased risk of having celiac disease.?
http://www.celiac.org/cd-cause.php
The following is an excerpt from a patient information guide from the
American Academy of Family Physicians (AAFP). It suggests some reasons
why the symptoms of Celiac Disease may appear later in life.
?Celiac disease runs in the family. You inherited the tendency to get
this disease from your parents. If 1 member of your family has celiac
disease, about 1 out of 10 other members of your family is likely to
have it. You may have this tendency for a while without getting sick.
Then something like severe stress, physical injury, infection,
childbirth or surgery can ?turn on? your celiac disease.?
http://familydoctor.org/236.xml
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SYMPTOMS
The National Digestive Diseases Information Clearinghouse (NDDIC) of
the NIH has a great website with very practical information for
patients. It gives a pretty comprehensive list of possible symptoms of
Celiac Disease.
?Celiac disease affects people differently. Symptoms may occur in the
digestive system, or in other parts of the body. For example, one
person might have diarrhea and abdominal pain, while another person
may be irritable or depressed. In fact, irritability is one of the
most common symptoms in children.
Symptoms of celiac disease may include one or more of the following:
* gas
* recurring abdominal bloating and pain
* chronic diarrhea
* pale, foul-smelling, or fatty stool
* weight loss / weight gain
* fatigue
* unexplained anemia (a low count of red blood cells causing fatigue)
* bone or joint pain
* osteoporosis, osteopenia
* behavioral changes
* tingling numbness in the legs (from nerve damage)
* muscle cramps
* seizures
* missed menstrual periods (often because of excessive weight loss)
* infertility, recurrent miscarriage
* delayed growth
* failure to thrive in infants
* pale sores inside the mouth, called aphthous ulcers
* tooth discoloration or loss of enamel
* itchy skin rash called dermatitis herpetiformis
A person with celiac disease may have no symptoms. People without
symptoms are still at risk for the complications of celiac disease,
including malnutrition. The longer a person goes undiagnosed and
untreated, the greater the chance of developing malnutrition and other
complications. Anemia, delayed growth, and weight loss are signs of
malnutrition: The body is just not getting enough nutrients.
Malnutrition is a serious problem for children because they need
adequate nutrition to develop properly.?
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
This is a similar listing of symptoms from a Journal of the American
Medical Association (JAMA) patient information sheet.
?Celiac disease symptoms may start in childhood or adulthood, with
onset and severity influenced by the amount of gluten that is eaten.
Symptoms include:
* Stomach pain, gas, and bloating
* Chronic diarrhea
* Pale, foul-smelling bowel movements
* Weight loss
* Bone or joint pain
* Dermatitis herpetiformis, a painful rash of itchy blisters
* Stunted growth (in children)?
http://jama.ama-assn.org/cgi/content/full/293/19/2432
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WHEN TO CONSULT A PHYSICIAN
Ultimately, when the symptoms become worrisome enough to entertain the
diagnosis of significant conditions such as Celiac Disease, it is
advisable to see a licensed medical practitioner who can order and
perform testing that will give a definitive diagnosis. The NIDDC
points out that the symptoms of Celiac Disease are so similar to those
of other conditions that it can be misdiagnosed for many years. Other
diseases and conditions that are commonly confused with Celiac Disease
are irritable bowel syndrome, iron-deficiency anemia caused by
menstrual blood loss, Crohn's disease, diverticulitis, intestinal
infections, and chronic fatigue syndrome.
?Recently, researchers discovered that people with celiac disease have
higher than normal levels of certain autoantibodies in their blood.
Antibodies are protective proteins produced by the immune system in
response to substances that the body perceives to be threatening.
Autoantibodies are proteins that react against the body's own
molecules or tissues. To diagnose celiac disease, physicians will
usually test blood to measure levels of
* Immunoglobulin A (IgA)
* anti-tissue transglutaminase (tTGA)
* IgA anti-endomysium antibodies (AEA)
Before being tested, one should continue to eat a regular diet that
includes foods with gluten, such as breads and pastas. If a person
stops eating foods with gluten before being tested, the results may be
negative for celiac disease even if celiac disease is actually
present.?
Tissue biopsy may be performed after a positive test to confirm the
diagnosis, or in cases where the initial testing is inconclusive.
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#4
There is an article that appeared in American Family Physician, the
journal of the AAFP that discussed Celiac Disease in some detail. In
the conclusion it mentions again how Celiac Disease can resemble many
other disorders. Early consultation with a physician may help to
arrive at the correct diagnosis sooner.
?Physicians may find themselves unsuccessfully pursuing expensive
tests to explain a patient's persistent symptoms or laboratory
abnormalities. A high index of suspicion is required to diagnose
celiac disease. A physician should consider celiac disease in a
patient with a confounding presentation.?
http://www.aafp.org/afp/980301ap/pruessn.html
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TREATMENTS
According to the NIDDC website, there is no cure for Celiac Disease,
but following a gluten-free diet can often help the symptoms to
disappear. Their site has a great list of example foods to consider
when avoiding gluten.
?For most people, following this diet will stop symptoms, heal
existing intestinal damage, and prevent further damage. Improvements
begin within days of starting the diet. The small intestine is usually
completely healed in 3 to 6 months in children and younger adults and
within 2 years for older adults. Healed means a person now has villi
that can absorb nutrients from food into the bloodstream.?
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#5
Here is a partial listing of gluten-free foods from the Mayo Clinic website.
?There are still many basic foods allowed in a gluten-free diet. These include:
* Fresh meats, fish and poultry (not breaded or marinated)
* Most dairy products
* Fruits
* Vegetables
* Rice
* Potatoes
* Gluten-free flours (rice, soy, corn, potato)?
Foods that they caution patients to avoid (unless specifically labeled
as ?gluten free?) include:
* Breads
* Cereals
* Crackers
* Pasta
* Cookies
* Cakes and pies
* Gravies
* Sauces
http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=8
This is a link to the Grains and Flours glossary on the Celiac Sprue
Association?s website.
http://www.csaceliacs.org/gluten_grains.php
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USEFUL WEBSITES
Some of these are listed above in my answer, and others are here in
case you want to read more. All of them have excellent information.
This is a Medline Plus listing of resources about Celiac Disease
http://www.nlm.nih.gov/medlineplus/celiacdisease.html
The NDDIC overview is an excellent resource as well.
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
This AAFP patient information site has very easy-to-read and practical information.
http://familydoctor.org/236.xml
The JAMA patient information site is another useful site, with good explanations.
http://jama.ama-assn.org/cgi/content/full/293/19/2432
The Celiac Sprue Association has a great site, including gluten-free
diet information, recipes, information about the disease, etc.
http://www.csaceliacs.org/index.php
This is the American Family Physician article to which I referred
earlier. It is technical in nature, but interesting if you want to
read some of the ?medical literature? on the topic. It is a review
article, so it contains a lot of general information about the
symptoms, diagnosis, and treatment, as well as complications of Celiac
Disease.
http://www.aafp.org/afp/980301ap/pruessn.html
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I hope that you find this information useful! Again, any concerns
about symptoms or treatments of any medical conditions should be
discussed with a qualified medical professional who you trust. If you
have need of any further clarification, please let me know how I can
help.
Sincerely,
Boquinha-ga
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