Celiac disease aka celiac sprue
Celiac Disease, also known as Celiac Sprue, is a digestive disease caused by an intolerance to gluten. Gluten is a protein found in wheat, rye and barley. People who have celiac disease should not eat most grain, pasta, cereal, and many processed foods. Failure to follow a gluten-free diet can damage the immune system, small intestine, and lead to malabsorption or malnutrition. When food containing gluten is eaten, the immune system responds by damaging or destroying villi, tiny, fingerlike protrusions lining the small intestine.
Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, you become malnourished no matter how much food you eat.
Symptoms of Celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Long-term complications for both adults and children include malnutrition—which can lead to anemia, osteoporosis, and miscarriage, among other problems—liver diseases, and cancers of the intestine. For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in three to six months in children but may take several years in adults. A healed intestine means you now have villi that can absorb nutrients from food into the bloodstream.
Adults: Many adults have the disease for a decade or more before they are diagnosed. 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. The longer you go undiagnosed and untreated, the greater the chance of developing long-term complications. Adults symptoms may include the following:
Diagnosing Celiac Disease
Diagnosing Celiac Disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac Disease can be confused with Irritable Bowel Syndrome (IBS), iron-deficiency anemia caused by menstrual blood loss, Inflammatory Bowel Disease, Diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, Celiac Disease has long been under diagnosed or misdiagnosed. Some of the tests used by Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; include:
- Blood Tests: People with Celiac Disease have higher than normal levels of certain autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. To diagnose Celiac Disease, Dr. Singh or Dr. Rashbaum will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but Celiac Disease is still suspected, additional blood tests may be needed.
- Intestinal Biopsy: If blood tests and symptoms suggest Celiac Disease, a biopsy of the small intestine is performed to confirm the diagnosis. During the biopsy, Dr. Singh, Dr. Rashbaum, or Dr. Nitin Parikh will remove a tiny piece of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, a long, thin tube called an Endoscope is guided through the and stomach into the small intestine. Sample tissue is then taken using instruments passed through the Endoscope.
- Dermatitis Herpetiformis: Dermatitis Herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with Celiac Disease. The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of Celiac Disease. DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, you do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as dapsone. Because dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.
- Screening: Screening for celiac disease means testing for the presence of autoantibodies in the blood in people without symptoms. Because Celiac Disease is hereditary, family members of a person with the disease may wish to be tested.
There is no cure for Celiac disease; however, a gluten-free diet can stop all symptoms. Your physician might suggest that Celiac Disease patients work with a Registered Dietitian to learn how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.
A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. Despite these restrictions, people with Celiac Disease can eat a well-balanced diet with a variety of foods. “Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with Celiac Disease can freely eat these foods. The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with Celiac Disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they grab for a snack. Eating out can be a challenge. When in doubt about a menu item, you should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.
Gluten is also used in some medications – ask your pharmacist if your prescribed medications contain wheat. Gluten is sometimes used as an additive in unexpected products—such as lipstick and play dough—reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature!
Board-Certified physicians Dr. Ranvir Singh, Dr. Stephen Rashbaum, Dr. Nitin J. Parikh, Dr. Long B. Nguyen, Dr. Ruth Montalvo, Dr. Jae Kim, and providers Tammi D’Elena, PA-C and Vanessa T. Bridgeman, MSN, APRN, FNP-BC; care for patients in the North Atlanta, GA; area including Johns Creek, GA, Cumming, GA, Lawrenceville, GA, Alpharetta, GA, and Dawsonville, GA. The in-house endoscopy suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems, abdominal pain, or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.