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Celiac Disease : Gluten Allergy

By David R. Neiblum, M.D., Gastroenterologist
The Chester County Hospital

Published: December 31, 2007

Celiac disease, or gluten allergy, is a digestive disease wherein the body cannot tolerate certain grains, and inflammation develops in the small intestine when exposure to these grains occurs. Gluten is a protein commonly found in wheat, barley and rye, and although not technically in oats, there is often cross-contamination of oats with gluten as well.

When someone with Celiac disease eats these foods (or a food that even has tiny traces of gluten, such as soy sauce, ketchup or licorice), their immune system responds by damaging the small intestine. They often develop symptoms including diarrhea, bloating or abdominal cramps. Sometimes a low blood count - anemia - will develop, and a patient will experience fatigue or shortness of breath as a result. A red rash can occur - dermatitis herpetiformis - and occasionally a person is found to have Celiac upon visiting a dermatologist. Other symptoms may be loss of tooth enamel, sores in the mouth, infertility, and growth problems in children. Often, however, the symptoms can be very mild or not present at all, and patients are commonly not diagnosed with Celiac for many years.

Although Celiac disease, also called Celiac Sprue, is found in many populations, it is more common in those of northern European descent. It often runs in families, and it is more common in people with diabetes. Celiac disease is thought to affect 1% of all Americans, but due to frequent lack of symptoms, only 1 out of 20 affected have been diagnosed thus far.

The disease is diagnosed by a combination of blood tests, in which antibodies to gluten proteins are found in the blood, and then by a biopsy of the small intestine. The biopsy is done during an upper endoscopy to definitively confirm the condition. The endoscopy takes less than 10 minutes, and since the patient is lightly sedated it is a completely painless procedure. A pencil-thin scope is passed into the stomach and then into the first part of the intestine, where the damaged bowel lining can be visualized and biopsied.

Once the diagnosis has been made, it is imperative that that person be on a completely gluten-free diet, not only to reverse the intestinal damage and any symptoms, but to prevent long-term complications. These complications can be serious, and can include osteoporosis and certain cancers, such as lymphoma and cancer of the small intestine.

Persons with Celiac should read extensively about a gluten-free diet. A meeting with a nutritionist well-versed in Celiac is also recommended to learn about the hidden sources of gluten, like envelope and stamp glue, certain medicines, vitamins, and many processed foods. Persons with Celiac also need to be careful about eating in restaurants, and make sure the chef is aware of their dietary restrictions. Some area supermarkets now have gluten-free sections, and many sources of information and foods are available online at such sites as www.celiac.org.

Patients with any of the above symptoms should see their doctor for the celiac blood test as the first step toward a definitive diagnosis.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009