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A lifelong digestive disorder, found in individuals who are genetically susceptible, that results in damage to the small intestine by interfering with the absorption of nutrients. Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the culprit. Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with CD. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, rye, barley, and tritcale. Damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten.

What Happens
When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food are damaged. This is due to an immunological reaction to gluten. Damaged villi interferes with the body's ability to absorb basic nutrients -- proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts. If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders -- both nutritional and immune related.

Some long-term conditions that can result from untreated CD:
Iron deficiency Anemia
Osteoporosis
Vitamin K deficiency associated with risk for hemorrhaging
Vitamin and mineral deficiencies
Central and peripheral nervous system disorders -- usually due to unsuspected nutrient deficiencies
Pancreatic insufficiency
Intestinal Lymphomas and other GI malignancies
Other food sensitivities/lactose intolerance
Other associated autoimmune disorders:
Dermatitis Herpetiformis (DH)
Insulin-dependent Diabetes Mellitus
Thyroid Disease
Systemic Lupus Erythematosus
Selective IgA Deficiencies
Primary Biliary Cirrhosis
Less commonly linked to CD:
Addisons Disease
Chronic Active Hepatitis
Downs Syndrome
Myasthenia Gravis
Rheumatoid Arthritis
Scleroderma
Sjogrens Syndrome

Who Gets Celiac Disease
Recent studies suggest that at least 1 in every 133 persons in the United States is affected. This prevalence is no statistically different from 1% approximation of the worldwide prevalence of CD. CD occurs in 5-15% of the offspring and siblings of a celiac. In 70% of identical twin pairs, both twins have the disease. It is suggested that family members be tested, even if asymptomatic. Patients with IgA deficiency should consult with an experienced pathologist to ensure proper diagnosis.

Cause
The cause of Celiac Disease, also called 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.

Symptoms
CD may appear at any time in the life of a person with a hereditary pre-disposition. Many patients are asymptomatic for years, with the disease becoming active for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. Symptoms of CD are extremely varied and cam mimic other bowel disorders and even psychiatric complaints. Infants, toddlers and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes.
Classic symptoms may include:
abdominal cramping, intestinal gas, distention and bloatingchronic diarrhea or constipation (or both)steatorrhea -- oily stoolsanemia - unexplained, due to folate, B12, B6, or iron deficiency (or all)
weight loss with large appetite, or weight gain
Other symptoms: dental enamel defectsosteopenia, osteoporosisbone or joint pain,fatigue, weakness and lack of energy infertility - male/female depression, aphthous ulcers

Dermatitis Herpetiformis (DH), is the associated skin condition characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on elbows,knees and buttocks. DH patients can have gastro-intestinal damage without perceptible symptoms.

Diagnosis
A person seeking preliminary diagnosis must be consuming gluten. Specific antibody blood tests are used to identify the possibility of Celiac Disease and are the initial step in screening. Recommended blood tests are: Anti-Gliadin (AGA) IgA, (AGA) IgG, Anti-Endomysial (EMA) IgA, Anti-tissue transglutaminase (tTG) and total serum IgA. It is essential that patients with positive antibody test have a small bowel biopsy (gold standard) to confirm the diagnosis and assess the degree of mucosal damage. This procedure is done endoscopicallly, on an out-patient basis. Hospitalization is not usually required.
Dermatitis Herpetiformis (DH) is diagnosed by a biopsy of a skin lesion and staining for IgA in the tissues. More than 85% of DH patients have small-bowel sensitivity to gluten. An experienced CD/DH pathologist is essential to establish these diagnoses. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Click here for celiac studies information. Dermatitis Herpetiformis can occur at any age. The average age of onset is 28 years old. It is usually not found in children. When it does occur before age 20, there is a slight female predominance. After age 20, it is more common in men than women.

Treatment
The only treatment for CD/DH is the life-long adherence to gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improved. Medication is normally not required. Because osteopenic bone disease is common and may be profound in patients with newly diagnosed Celiac Disease, bone densomitry should be measured in adults at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. All patients should be monitored by their physician to ensure compliance with, and response to the gluten-free diet. Dietary compliance decreases the likelihood of osteoporosis, lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is crucial to read labels which are often imprecise, and learn to identify ingredients that may contain hidden gluten. Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Potential harmful ingredients include:
Brown rice syrup (frequently made from barley) Caramel color (infrequently made from barley) Dextrin (usually corn, but may be derived from wheat) Flour or cereal products Malt or malt flavoring (usually made from barley. Okay if made from corn) Malt vinegar Modified food starch (from unspecified or forbidden source) Soy sauce or soy sauce solids (many soy sauces contain wheat)

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Alcohol and vinegar that are properly distilled should not contain any harmful gluten peptides (or prolomines). Research indicates that the gluten peptide is too large to carry over in the distillation process. This leaves the resultant liquid gluten-free unless a gluten-containing additive is inserted after the distillation process. Alcohols and vinegars should be carefully investigated for additives before use. Malt vinegars are not distilled and therefore are not gluten-free. 
Celiac Disease