Celiac Disease

As many as 75 percent of children with celiac disease are overweight or obese. Digestive signs and symptoms are experienced by 20 to 30 percent of children with the condition although the precise signs and symptoms differ by age.

In infants, typical signs and symptoms of celiac disease include:

Older children may experience:

Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.

Dermatitis herpetiformis is often associated with changes to the lining of the small intestine identical to that of celiac disease, but the disease may not produce noticeable digestive symptoms.

Dermatitis herpetiformis is treated with a gluten-free diet and medication to control the rash.

The precise cause of celiac disease isn’t known.

When the body’s immune system overreacts to gluten in food, the immune reaction damages the tiny, hair-like projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. Normally, villi resemble the deep pile of a plush carpet, on a microscopic scale. The damage resulting from celiac disease makes the inner surface of the small intestine appear more like a tile floor. As a result your body is unable to absorb nutrients necessary for health and growth.

A study done by Mayo Clinic and the National Institutes of Health estimates that about 1 in 141 people

in the U.S. have celiac disease, although the disease of- ten goes undiagnosed. Celiac disease is most common in Caucasians.

Some gene changes (mutations) appear to increase the risk of developing the disease. But having those gene mutations doesn’t mean you’ll get celiac disease — meaning other factors must be involved.

Sometimes celiac disease is triggered — or becomes active for the first time — after surgery, pregnancy, child- birth, viral infection or severe emotional stress.

Celiac disease can affect anyone. However, it tends to be more common in people who have:

Untreated, celiac disease can cause:

Malnutrition. The damage to your small intestine means it can’t absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause stunted growth and delayed development.
Loss of calcium and bone density. Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.
Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.
Lactose intolerance. Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don’t contain gluten. Once your intestine has

healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose in- tolerance despite successful management of celiac disease.

Cancer. People with celiac disease who don’t maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.

You may be referred to a doctor who treats digestive diseases (gastroenterologist).
Tests and procedures used to diagnose celiac disease include:

Blood tests. Elevated levels of certain substances in your blood (antibodies) indicate an immune reaction to gluten. These tests detect celiac disease even if you have only mild symptoms or none at all.
Endoscopy. If your blood tests indicate celiac disease, your doctor may order an endoscopy to view your small intestine and to take a small tissue sample (biopsy) to analyze for damage to the villi.

It’s important to be tested for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet may change the results of blood tests so that they appear to be normal.

A gluten-free diet is essential, and the only treatment for managing celiac disease. In addition to wheat, foods that contain gluten include:

Your doctor may refer you to a dietitian, who can help you plan a healthy gluten-free diet.

Once gluten is removed from the diet, inflammation in the small intestine generally begins to lessen — usually within several weeks, though you may start to feel better in just a few days. Complete healing and regrowth of the villi may take several months to several years. Healing in the small intestine tends to occur more quickly in children than adults.

If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn’t mean it’s not harmful. Even trace

amounts of gluten in your diet can be damaging, whether or not they cause signs or symptoms.

If your nutritional deficiencies are severe, your doctor or dietitian may recommend taking vitamin and mineral supplements. You may need to supplement your levels of:

Vitamin supplements are usually taken in pill form. If your digestive tract has trouble absorbing vitamins, your doctor may give them by injection.

If you have this itchy, blistering skin rash that some- times accompanies celiac disease, your doctor may recommend a skin medication (dapsone) along with the gluten- free diet.

Packaged foods should be avoided unless they’re labeled as gluten-free or have no gluten-containing ingredients. In addition to cereals, pastas and baked goods — such as breads, cakes, pies and cookies — other packaged foods that may contain gluten include:

*Certain grains, such as oats, can be contaminated with wheat during growing and processing. It’s not clear whether oats are harmful for most people with celiac disease, but