DEAR DR. GOTT: This is in regard to your article about the 15-year-old with chronic abdominal pain. Why didn’t you think of celiac disease? My granddaughter was diagnosed at age 6 after developing severe abdominal pain. She managed her celiac and is doing very well on a gluten-free diet.
DEAR READER: Your letter is just one of many I have received about this young girl’s problem.
Celiac disease (also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy) is a digestive disorder. These people cannot tolerate the protein gluten, which is found in wheat, rye and barley. These grains are present in many foods, even some nonfood items, such as vitamins and medications.
Celiac is sort of a double-whammy. It is both an autoimmune disorder and a malabsorption disease. It is considered autoimmune because in the presence of gluten, the body overreacts and begins destroying the villi. These tiny, finger-like projections line the intestine and allow nutrients to be absorbed into the bloodstream. This is where celiac is also considered a malabsorption disease, because without healthy villi, the body cannot take in proper amounts of nutrients regardless of how much food is consumed.
Celiac can be difficult to diagnose because symptoms can vary greatly between sufferers, and most only have general complaints. In infants and young children, some of the more common symptoms can include weight loss, chronic diarrhea, constipation, vomiting, irritability, abdominal pain and bloating, and pale, foul-smelling or fatty stool. Even if these symptoms are not present, malabsorption can still be a problem and may lead to delayed growth, short stature, delayed puberty, dental defects in permanent teeth and more.
In adults, digestive symptoms are less common. They may have unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, canker sores, missed menstrual periods, depression, anxiety, osteoporosis, tingling numbness in the hands and feet, seizures, infertility, recurrent miscarriages and dermatitis herpetiformis (a type of skin rash).
Adults and children with the disorder may not have any symptoms; however, they are still at risk of developing complications over time. Complications include malnutrition, liver diseases and intestinal cancer.
Many people with celiac may also have type 1 diabetes, Sjogren’s syndrome, autoimmune thyroid or liver disease, Addison’s disease or rheumatoid arthritis. The connection is thought to be genetic.
If celiac disease is suspected, a physician can order a blood test to check the levels of certain autoantibodies, antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Not all sufferers will test positive, however, so intestinal biopsy may be performed to confirm the diagnosis. This is done during endoscopy. Another way to confirm the diagnosis is to have the patient begin a gluten-free diet. If the symptoms resolve, celiac may be diagnosed. It is important that this diet is not started without informing your physician because both the blood test and biopsy results can be altered.
The good news is that if the diet is started before permanent damage is done, most, if not all, damage can be reversed. Today, more and more foods, beverages and products are becoming available that are gluten-free, making following the diet easier. Traditional breads and pastas can be replaced with products made from other flours, such as rice, arrowroot and more.
Anyone interested in learning more can visit the websites of the American Celiac Disease Alliance (www.AmericanCeliac.org), the Celiac Disease Foundation (www.Celiac.org) or the Celiac Disease Awareness Campaign, a part of the National Digestive Diseases Information Clearinghouse and the National Institute of Diabetes and Digestive and Kidney Diseases (www.celiac.nih.gov).
