Celiac Disease

Celiac disease is a specific disease related to immunologic response to gluten in diet. The effects are not confined to the small bowel damage only, but involve increased risk of lymphoma, esophageal cancer, thinning of bones and many other problems. Diarrhea, bloating, and consequences of nutritional deficiencies are common with chronically active disease. 

It is not that simple. It is hard to be convinced about going through the pain of strictly eliminating gluten (not just wheat) from the diet unless one knows for sure that one is at risk of developing serious problems associated with celiac disease. Wheat is a common thickener added to many food products. Diagnosis makes a big difference.  Even doctors have to watch out for certain conditions which are not routinely checked in patients without celiac disease. 

Generally, blood tests and biopsies of small bowel during an endoscopy. The blood tests are: IgA antibodies to tTG and DGP. Biopsies show damage to finger-like extensions of the cells lining the small bowel called 'villi'. 

The first step is to go on a strict gluten-free diet (GFD). Wheat, barley and rye are out. Only if oat is not contaminated with gluten, it can be taken. Corn, rice, millet and sorghum are fine.  One has to religiously read the labels on food items in grocery stores. Now there are items labelled as gluten-free and they are safe to take. Occasionally, medications have to be prescribed.

Some patients may have skin condition (dermatitis herpetiformes), thinning of bones (osteoporosis), underactive thyroid gland, colitis or liver function abnormalities. Lymphoma can develop in jejunum after ulcers develop in the setting of long-term inflammation.

After starting gluten free diet (GFD) blood test is done to check antibody level in 3-6 months. If it normalizes, then patient is following GFD. Repeat biopsies are done if patient does not get better or in two years.