Celiac disease

Overview

Also known as celiac sprue or gluten-sensitive enteropathy, celiac disease causes damage to the small intestine in response to gluten consumption. Gluten is a protein found in wheat, barley, and rye products. Over time the damage to the small intestine’s lining often causes systemic symptoms and damage.  Sometimes an individual experiences no symptoms, which is known as asymptomatic celiac disease. 

Common Symptoms

The symptoms and signs can be categorized as digestive-related or non-digestive-related. Furthermore, the experiences of adults with celiac disease may be somewhat different from those of children.

Diarrhea, constipation – chronic or intermittent, bloating, pain (abdominal, intractable, severe, chronic), nausea, vomiting, weight loss/inability to gain weight, nutritional malabsorption, swollen belly, pale or particularly pungent stool, failure to crawl on stomach at 6 months and failure to settle and difficulty sleeping (for infants), mouth ulcers, headaches, migraines, fatigue, dizziness, palpitations/arrhythmia, joint and bone pain, bone growth issues (e.g., jaw, and/or stature), loss of menstruation, delayed puberty, seizures, frequency of urination, emotional volatility, anxiety, depression, anemia, failure to form tooth enamel, chronic or frequent sinus infections, increased frequency of childhood and other diseases/illnesses, osteoporosis, osteomalacia, skin rashes, eczema, insomnia, lactose intolerance, vision changes or decline, tremors, balance issues, tingling or numbness in hands and/or feet, cognitive difficulties such as short and/or long-term memory loss, foggy brain, attention deficits, poor muscle coordination, frequent bruising (often brown in appearance), and fainting.

Coexisting Diseases and Conditions

This article, published in the peer-reviewed journal Nutrients, details a review of skin conditions seen in children with celiac disease. Some key takeaways include:

• Dermatitis Herpetiformis: is a skin manifestation of celiac disease that causes an itchy, burning rash. It is mostly seen in adult patients with celiac disease, with the average onset occurring between 30-40 years of age. It resolves itself with the removal of gluten from the diet, and typically only flares upon gluten ingestion.

• Chronic Urticaria: Children with celiac disease were found to be at a significantly higher risk of developing chronic urticaria than the general pediatric population. While the relationship between the two isn’t clear, the gluten-free diet helps to induce remission in both diseases.

• Atopic Dermatitis: Despite some conflicting data and no definitive link between the two, celiac disease testing is still encouraged if a child presents with atopic dermatitis, as it is frequently associated with environmental allergies and food allergies.

• Vitiligo: An increased frequency of celiac disease has been found in children with vitiligo.

Other coexisting diseases and conditions include type 1 diabetes, pernicious anemia, osteoporosis (loss of bone density)/osteomalacia (bone softening), hyposplenism (limited/reduced spleen function), Sjögren’s syndrome, autoimmune thyroid disorders, connective tissue disease, IgA deficiency, Postural Orthostatic Tachia Cardiac Syndrome (POTS), and liver and biliary tract disorders.

Risk Factors and Prevalence

HLA-DQ2 or HLA-DQ8 genes, with environmental triggers of ingestion of gluten. Note that approximately 40% of the population has these genes, but only about 3% of this group has celiac disease.

In rare cases, it has been reported that celiac disease has been triggered by pregnancy, childbirth, or viral infection, including Covid-19.  However, in some of these cases, celiac disease or gluten intolerance was already present and the triggers worsened the disease. 

One current school of thought holds that celiac disease may be a spectrum of gluten intolerance and that those with gluten intolerance with no evidence of intestinal villi damage have a milder form of celiac disease.

Risk factors include related family members with celiac disease or, with lesser percentages, other autoimmune diseases such as dermatitis herpetiformis, type 1 diabetes, Down syndrome or Turner syndrome, autoimmune thyroid disease, microscopic colitis, or Addison’s.