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What is Celiac Disease and How Does Gluten Affect It?
Gluten is something we hear about so often in our day-to-day lives - from news stories to menus to food labels. Yet many do not know what gluten really is.
What is gluten?
Gluten is a storage protein in foods that contain wheat, barley and rye. Some people may have a sensitivity to dietary gluten. When they eat a food that contains gluten, their immune system fights it by launching an allergic reaction on the small intestine. That reaction is called celiac disease, the condition associated with the body’s intolerance to gluten.
Understanding celiac disease
Your small intestine has a big job. It is responsible for absorbing most of the nutrients from your food, so your body has the energy and nutrition it needs. When people with celiac disease eat food with gluten, it can cause inflammation and damage to the small intestine.
As a result, it can ultimately lead to a condition known as malabsorption, which means your body is no longer able to get the nutrients it needs from your small intestine. In addition to the physical dangers it presents, it can also cause a severe amount of discomfort, or frequent trips to the bathroom, which could make for a rather unpleasant evening with your in-laws.
The symptoms and diagnosis
Symptoms of celiac disease may range from mild to severe in some, while others may have no symptoms at all. Symptoms may include:
- chronic diarrhea
- weight loss
- abdominal pain
- stool that floats
Celiac disease can be a serious condition. You should ask your doctor to be screened for the condition if you have:
- any of the above signs or symptoms
- lab results that indicate disorders associated with celiac disease, including malabsorption, iron deficiency anemia, abnormal liver tests, skin disorders or early bone disease
- a first degree relative with celiac disease
Diagnosis and testing
Celiac disease is diagnosed by performing a simple blood test called an anti-tissue transglutaminase (TTG) antibody. This test is done while you are still on a diet that contains gluten.
If the results are positive, we use a procedure called an intestinal biopsy, which is done through an upper endoscopy, to confirm the diagnosis. If these tests are inconclusive, your doctor may order additional blood work.
Treating celiac disease
Patients with celiac disease should adhere to a gluten-free diet for the duration of their lifetime. This requires strict avoidance of products containing proteins from wheat, barley and rye. Patients with celiac disease will also be referred to a knowledgeable dietitian, to help review what food products contain gluten and develop a healthy eating plan.
A gastroenterologist should continue to care for patients with celiac disease. It is important to monitor for:
- resolution of signs and symptoms associated with celiac disease
- blood testing for vitamin and nutrient levels
- blood testing to ensure adherence to a gluten-free diet and no accidental exposures
- a pneumonia vaccination
- a bone scan, which may also be recommended by your doctor
No matter the diagnosis, the sensitivity or allergy to gluten is becoming more and more prevalent in our society. Celiac disease is a chronic condition and it pays to be knowledgeable about its signs and symptoms, as well as its treatment.
Zilla H. Hussain, MD
Dr. Zilla Hussain is a gastroenterologist with the Lifespan Physician Group Gastroenterology and the Center for Women's Gastrointestinal Medicine at the Women’s Medicine Collaborative. Her clinical and research interests include gastrointestinal reflux disease, and disorders of the esophagus, including Barrett’s esophagus, eosinophilic esophagitis, and achalasia.