Overview
Celiac disease also called as sprue or gluten-sensitive enteropathy is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. Gluten is a form of protein found in some grains. The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron, and folate.
Celiac disease is genetic, meaning it runs in families. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress. Although it may present at any age, there is a peak incidence in the 3rd decade with a smaller peak in the 5th and 6th decade.
Symptoms of the disease
Digestive problems which are also common in children (abdominal bloating, pain, gas, diarrhea, palefoul-smelling or fatty stools that float, and weight loss)
Investigations
Blood test to measure for higher levels of certain types of antibodies (substances produced by the immune system to fight harmful invaders) found in people with celiac disease.Antitissue transglutaminase antibody assay is a sensitive and specific test for coeliac disease. The older anti- endomyseal and anti – gliadin antibody tests are also used.
Other tests to detect nutritional deficiencies, such as a blood test to detect iron levels; a low level of iron (which can cause anemia) can occur with celiac disease. A stool sample may be tested to detect fat in the stool, since celiac disease prevents fat from being absorbed from food.
Low calcium with normal or low phosphate maybe indicative of Osteomalacia.
Low urea is usual in any malabsorption.
Slight increase in liver transaminases is common.
Hypoalbuminemia is seen in severe malabsorption.
If blood tests suggest you have celiac disease, a biopsy from the duodenum is done to check for damage to the villi which will confirm the diagnosis.
If a biopsy and other blood tests do not clearly confirm celiac disease, genetic blood tests are done to check for certain gene changes, or variants.
Management
If you have celiac disease, you can’t eat any foods that contain gluten (including wheat, rye, barley, and oats). Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. In most cases, the villi are healed within six months. You’ll have to remain on this diet for the rest of your life; eating any gluten at all can damage the intestine and restart the problem.
Replacement of deficient vitamins. Strategies of bone density protection by giving calcium supplements.
Complications
Features of mineral and vitamin deficiency can occur.
Severe malnutrition result in severe hypoalbuminemia with consequent ascites and peripheral edema.
Osteopenia
Hyposplenism can predispose to infection.
There is an increased risk of developing T cell lymphoma of small intestine and other GI malignancies.