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Coeliac Disease (celiac disease, sprue, nontropical sprue, gluten-sensitive enteropathy) : Symptoms, Causes, Diagnosis and Treatment

What is Coeliac Disease?

Celiac disease is a chronic digestive disorder resulting from an immune reaction to gliadin, a gluten protein found in wheat, barley, rye, and sometimes oats.

It involves inflammation and destruction of the inner lining of the small intestine and can lead to the malabsorption of minerals and nutrients.

Symptoms may include chronic diarrhea, weight loss, and fatigue. In some cases, the only symptom is anemia, and celiac disease is not be diagnosed until later in life.

Celiac disease affects about 1 in 141 Americans. It can affect a person of any age who is genetically predisposed, but it often begins in middle infancy.

Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

In children, malabsorption can affect growth and development, besides causing the symptoms seen in adults.

There's no cure for celiac disease ? but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

Coeliac Disease is also known as celiac disease, sprue, nontropical sprue, gluten-sensitive enteropathy. Coeliac Disease belongs under the category of Auto imune disease. Generally Rare in Male and child, common in Female. are the victim of the Coeliac Disease. Seriousness of this disease is Low.

Symptoms of Coeliac Disease are :

  • repeated miscarriages
  • liver abnormalities
  • Your liver is a key part of your digestive system, responsible for cleaning out toxins from your blood, processing medicines, producing bile, helping you digest fat, storing glucose and producing proteins for clotting your blood, among many other things.

  • tingling or numbness in the feet
  • tingling or numbness in the hands
  • stomach pain
  • Abdominal swelling
  • Mouth ulcers
  • diarrhea
  • Diarrhea is characterized by loose, watery stools or a frequent need to have a bowel movement. It usually lasts a few days and often disappears without any treatment. Diarrhea can be acute or chronic.

    Acute diarrhea occurs when the condition lasts for one to two days. You might experience diarrhea as a result of a viral or bacterial infection. Other times, it could be due to food poisoning.

    There?s even a condition known as traveler?s diarrhea, which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.

    Chronic diarrhea refers to diarrhea that lasts for at least four weeks. It?s usually the result of an intestinal disease or disorder, such as celiac disease or Crohn?s disease.

  • Weight loss
  • Sudden, noticeable weight loss can happen after a stressful event, although it can also be a sign of a serious illness.

    It's normal to lose a noticeable amount of weight after the stress of changing jobs, divorce, redundancy or bereavement.

    Weight often returns to normal when you start to feel happier, after you've had time to grieve or get used to the change. Counselling and support may be needed to help you get to this stage.

    Significant weight loss can also be the result of an eating disorder, such as anorexia or bulimia. If you think you have an eating disorder, talk to someone you trust and consider speaking to your GP. There are also several organisations that can provide you with information and advice, such as the eating disorders charity Beat.

    If your weight loss wasn't due to one of the causes mentioned, and you didn't lose weight through dieting or exercising, see your GP, as you may have an illness that needs treating.

  • Skin rash
  • Itchy skin, also known as pruritus, is an irritating and uncontrollable sensation that makes you want to scratch to relieve the feeling. The possible causes for itchiness include internal illnesses and skin conditions.

    It?s important to see a doctor for itchiness if the cause isn?t obvious. A doctor can find the underlying cause and provide treatments for relief. Several home remedies such as over-the-counter creams and moisturizers work well for itching.

  • Vomiting
  • Vomiting, or throwing up, is a forceful discharge of stomach contents. It can be a one-time event linked to something that doesn?t settle right in the stomach. Recurrent vomiting may be caused by underlying medical conditions.

    Frequent vomiting may also lead to dehydration, which can be life-threatening if left untreated.

  • Nausea
  • Nausea and vomiting are common signs and symptoms that can be caused by numerous conditions. Nausea and vomiting most often are due to viral gastroenteritis ? often mistakenly called stomach flu ? or the morning sickness of early pregnancy.

    Many medications can cause nausea and vomiting, as can general anesthesia for surgery. Rarely, nausea and vomiting may indicate a serious or even life-threatening problem.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

    Causes

    Coeliac Disease can be caused due to:

    Celiac disease is an immune disorder. When a person with celiac disease eats gluten, their cells and immune systems are activated and attack and damage the small intestine.

    In celiac disease, the immune system mistakenly attacks the villi in the small intestine. These become inflamed and impacted, and they may disappear. The small intestine is no longer able to absorb nutrients effectively. This can lead to a number of health risks and complications.

    People who are more likely to have celiac disease include those with:

    • another autoimmune disease, such as type 1 diabetes, rheumatoid arthritis, or an autoimmune disease that affects the thyroid or the liver
    • a genetic disorder, such as Down syndrome or Turner syndrome
    • a family member who has the disease

    Having a family member with celiac disease increases a person?s chance of having it to 1 in 10.

    Treatment for the Coeliac Disease

    Diagnosis:

    Many people with celiac disease don't know they have it. Two blood tests can help diagnose it:

    • Serology testing looks for antibodies in your blood. Elevated levels of certain antibody proteins indicate an immune reaction to gluten.
    • Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out celiac disease.

    It's important to be tested for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet might make the results of blood tests appear normal.

    If the results of these tests indicate celiac disease, your doctor will likely order one of the following tests:

    • Endoscopy. This test uses a long tube with a tiny camera that's put into your mouth and passed down your throat (upper endoscopy). The camera enables your doctor to view your small intestine and take a small tissue sample (biopsy) to analyze for damage to the villi.
    • Capsule endoscopy. This test uses a tiny wireless camera to take pictures of your entire small intestine. The camera sits inside a vitamin-sized capsule, which you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder.

    If your doctor suspects you have dermatitis herpetiformis, he or she might take a small sample of skin tissue to examine under a microscope (skin biopsy).

    Common blood tests include:

    • complete blood count (CBC)
    • liver function tests
    • cholesterol test
    • alkaline phosphatase level test
    • serum albumin test

    Treatment:

    A strict, lifelong gluten-free diet is the only way to manage celiac disease. Besides wheat, foods that contain gluten include:

    • Barley
    • Bulgur
    • Durum
    • Farina
    • Graham flour
    • Malt
    • Rye
    • Semolina
    • Spelt (a form of wheat)
    • Triticale

    A dietitian who works with people with celiac disease can help you plan a healthy gluten-free diet. Even trace amounts of gluten in your diet can be damaging, even if they don't cause signs or symptoms.

    Gluten can be hidden in foods, medications and nonfood products, including:

    • Modified food starch, preservatives and food stabilizers
    • Prescription and over-the-counter medications
    • Vitamin and mineral supplements
    • Herbal and nutritional supplements
    • Lipstick products
    • Toothpaste and mouthwash
    • Communion wafers
    • Envelope and stamp glue
    • Play dough

    Removing gluten from your diet will gradually reduce inflammation in your small intestine, causing you to feel better and eventually heal. Children tend to heal more quickly than adults.

    Vitamin and mineral supplements

    If your anemia or nutritional deficiencies are severe, your doctor or dietitian might recommend that you take supplements, including:

    • Copper
    • Folate
    • Iron
    • Vitamin B-12
    • Vitamin D
    • Vitamin K
    • Zinc

    Vitamins and supplements are usually taken in pill form. If your digestive tract has trouble absorbing vitamins, your doctor might give them by injection.

    Follow-up care

    Medical follow-up at regular intervals can ensure that your symptoms have responded to a gluten-free diet. Your doctor will monitor your response with blood tests.

    For most people with celiac disease, a gluten-free diet will allow the small intestine to heal. For children, that usually takes three to six months. For adults, complete healing might take several years.

    If you continue to have symptoms or if symptoms recur, you might need an endoscopy with biopsies to determine whether your intestine has healed.

    Medications to control intestinal inflammation

    If your small intestine is severely damaged or you have refractory celiac disease, your doctor might recommend steroids to control inflammation. Steroids can ease severe signs and symptoms of celiac disease while the intestine heals.

    Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris), might be used.

    Treating dermatitis herpetiformis

    If you have this skin rash, your doctor might recommend a medication such as dapsone, taken by mouth, as well as a gluten-free diet. If you take dapsone, you'll need regular blood tests to check for side effects.

    Refractory celiac disease

    If you have refractory celiac disease, your small intestine won't heal. Then you'll likely need to be evaluated in a specialized center. Refractory celiac disease can be quite serious, and there is currently no proven treatment.

    Possible complication with Coeliac Disease

    If you have coeliac disease, it's crucial you do not eat any gluten. If you have untreated or undiagnosed coeliac disease and you're still eating gluten, several complications can occur.

    It's a common misconception that eating a little gluten will not harm you. Eating even tiny amounts can trigger symptoms of coeliac disease and increase your risk of developing the complications outlined below.

    Malabsorption

    Malabsorption (where your body does not fully absorb nutrients) can lead to a deficiency of certain vitamins and minerals. This can cause conditions such as:

    Malnutrition

    As coeliac disease causes your digestive system to work less effectively, severe cases can sometimes lead to a critical lack of nutrients in your body. This is known as malnutrition, and can result in your body being unable to function normally or recover from wounds and infections.

    If you have severe malnutrition, you may become fatigued, dizzy and confused. Your muscles may begin to waste away and you may find it difficult to keep warm. In children, malnutrition can cause stunted growth and delayed development.

    Treatment for malnutrition usually involves increasing the number of calories in your diet and taking supplements.

    Read more about treating malnutrition.

    Lactose intolerance

    If you have coeliac disease, you're more likely to also develop lactose intolerance, where your body lacks the enzyme to digest the milk sugar (lactose) found in dairy products. Lactose intolerance causes symptoms such as bloating, diarrhoea and abdominal discomfort.

    Unlike gluten in coeliac disease, lactose does not damage your body. But you may get some gut-related symptoms when you eat foods containing lactose because you can't digest it properly.

    Lactose intolerance can be effectively treated by not eating and drinking dairy products that contain lactose. You may also need to take calcium supplements ? dairy products are an important source of calcium, so you'll need to compensate for not eating them.

    Read more about treating lactose intolerance.

    Cancer

    Cancer is a very rare but serious complication of coeliac disease.

    Someone with coeliac disease has a slightly increased risk of developing certain cancers. Recent research shows that this increased risk is less than previously thought.

    Cancers associated with coeliac disease are small bowel cancer, small bowel lymphoma and Hodgkin lymphoma. However, most people with coeliac disease will not develop any of these.

    If you've been following a gluten-free diet for 3 to 5 years, your risk of developing these types of cancer is the same as that of the general population.

    Coeliac disease in pregnancy

    Poorly controlled coeliac disease in pregnancy can increase the risk of developing pregnancy-related complications, such as giving birth to a baby with a low birthweight.

    Coeliac UK has more information and advice about coeliac disease and pregnancy. You can also read more about healthy eating in pregnancy.

    References:

    1 https://www.nhs.uk/conditions/coeliac-disease/complications/ 2 https://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease-treatment#1 3 https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225 4 https://www.healthline.com/health/celiac-disease-sprue#treatment 5 https://www.medicalnewstoday.com/articles/38085#treatment

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