What is Celiac Disease?
Also known as celiac sprue, celiac disease is an immunologically mediated disorder leading to an inflammatory response of the digestive tract resulting in an inability of the patient to tolerate gliadin or gluten. The mucosa of the intestine is damaged causing malabsorption of food nutrients and maldigestion. Wheat, rye, barley, etc. are gluten-rich foods. Individuals with celiac disease are sensitive to gluten and ingesting these foods interferes with the digestion. The etiology of celiac disease is usually a combination of environmental factors, genetic factors and immunological responses.
Genetics and heredity – Patients with relatives who have had celiac disease present with a greater incidence of acquiring the disease
Gliadin – Gliadin intake produces histological changes in patients with asymptomatic celiac disease; when gluten interacts with the mucosa of the small intestine endogenous tissue convert the gluten into a negatively-charged protein, which is consequent in the production of killer cells such as T lymphocytes.
Signs and Symptoms
- Abdominal pain
- Weight loss
- Digestive problems – bloating and pale stools
- Neurologic symptoms – paresthesias, ataxia, motor weakness, seizures
- Infertility in women
- Delayed menarche
- Skin rashes – dermatitis hyperpetiformis
- Tingling in the legs
- Musculoskeletal problems – joint pain and bone pain
- Aphthous ulcers
Accompanying health problems of celiac disease
- Birth defects
- Rare cancer of the intestine
- Thyroid disease
- Type 1 diabetes
- Sjogren’s syndrome
- Rheumatoid arthritis
Physical examination reveals a tympanic abdomen; the presence of distended intestinal loops containing gas and fluids is observed. Ascites is also noted due to severe hypoproteinemia.
There is also evidence of:
- Loose skin folds
- Peripheral oedema
- Peripheral neuropathy
- Trousseau or Chvostek sign
- Lab studies will include:
- Detection of electrolyte imbalances
- Check for evidence of malnutrition
- Haematologic tests – PT for malabsorption of vitamin K
- Stool test for malabsorption of fat
- Oral tolerance test like lactose tolerance test to check for malabsorption of carbohydrates
- Genetic testing
- Radiologic studies can include small bowel barium swallow study
- Upper endoscopy with duodenal bioscopies
Treatment and medication
Medical management of celiac disease may include dietary changes such as the elimination of gluten-rich products. Corticosteroids are prescribed to patients who do not respond well to dietary changes. Prednisone, Deltasone, Orasone and Sterapred are some of the corticosteroids used in the treatment of refractory celiac disease. Their anti-inflammatory properties help modify the body’s immune response.
Dr. Deepak has a systematic approach to the treatment of celiac disease. He prescribes medication only after grading the duodenal biopsies.