Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Depending on the degree of malabsorption, the signs and symptoms of celiac disease vary among individuals, ranging from no symptoms, few or mild signs and symptoms, to many or severe signs and symptoms. There are two categories of signs and symptoms:
1) signs and symptoms due to malabsorption, and 2) signs and symptoms due to malnutrition including vitamin and mineral deficiencies.
1. Signs and symptoms due to malabsorption: Fat is the most commonly
and severely affected nutrient in celiac disease. Gastrointestinal symptoms of
fat malabsorption include:
diarrhea,
foul smelling gas,
increased amount of fat in the stool,
and
abdominal bloating.
2. Signs and symptoms due to malnutrition including vitamin and mineral
deficiencies include:
weight loss,
fluid retention,
anemia,
osteoporosis,
bruising easily,
peripheral neuropathy,
infertility, and
muscle weakness.
Celiac disease facts
Celiac disease is a chronic digestive disorder in which
damage to the lining of the small intestine leads to the malabsorption of
minerals and nutrients.
The destruction of the inner lining of the small
intestine in celiac disease is caused by an immunological (allergic) reaction to
gluten.
Gluten is a family of proteins present in wheat,
barley, rye, and sometimes oats.
Individuals with celiac disease may develop diarrhea,
steatorrhea, weight loss,
flatulence, iron deficiencyanemia, abnormal
bleeding, or weakened bones. However, many adults with celiac disease may have
either no symptoms or only vague abdominal discomfort such as bloating,
abdominal distension, and excess gas.
Children with celiac disease may have stunted
growth, and if untreated, childhood celiac disease can result in short stature
as an adult.
Small intestinal biopsy is considered the most
accurate test for celiac disease.
Blood tests can be performed to diagnose celiac
disease; these include endomysial antibodies, anti-tissue transglutaminase
antibodies, and anti-gliadin antibodies.
There is no cure for celiac disease. The treatment of
celiac disease is a gluten free diet.
In most individuals, a gluten free diet will result in
improvement in symptoms within weeks. Many individuals report symptom
improvement within 48 hours.
In children with celiac disease, successful treatment
with a gluten free diet can lead to the resumption in growth (with rapid catch
up in height).
Failure to respond to a gluten free diet can be due to
several reasons; the most common reason is failure to adhere to a strict
gluten free diet.
Refractory celiac disease is a rare condition in which the
symptoms of celiac disease (and the loss of villi) do not improve despite many
months of a strict gluten free diet. It may progress to cancer.
The treatment of refractory celiac disease is first to make
sure that all gluten is eliminated from the diet. If there still is no
improvement, corticosteroids such as prednisone, and immunosuppressive agents
(medications that suppress a person's immune system) such as azathioprine and
cyclosporine may be used.
Adults with celiac disease have a several-fold higher
than normal risk of developing lymphomas (cancers of the lymph glands) in the
small intestine and elsewhere. They also have a high risk of small intestinal
and, to a lesser degree, of esophageal carcinomas (cancers of the inner lining
of the intestine and esophagus).
The prognosis of individuals with celiac disease who develop lymphoma, collagenous
celiac disease, or jejunal ulcers is poor.
What is celiac disease?
Celiac disease is a disease of the small intestine. The small intestine
is a 22 foot long tube that begins at the stomach and ends at the large intestine (colon). The first
10 inches (25cm) of the small intestine (the part that is attached
to the stomach) is called the duodenum, the middle part is called the jejunum,
and the last part (the part that is attached to the colon) is called the ileum. Food
empties from the stomach into the small intestine where it is digested and
absorbed into the body. While food is being digested and absorbed, it is
transported by the small intestine to the colon. What enters the colon is
primarily undigested food. In celiac disease, there is an immunological (allergic)
reaction within the inner lining of the small intestine to proteins (gluten) that are present in wheat,
rye, barley and, to a lesser extent, in oats. The immunological reaction causes
inflammation that destroys the lining of the small intestine. This reduces the
absorption of the dietary nutrients and can lead to
symptoms and signs of nutritional, vitamin, and mineral deficiencies.
The other terms used forceliac disease include sprue, nontropical sprue, gluten enteropathy, and
adult celiac disease. (Tropical sprue is another disease of the small intestine
that occurs in tropical climates. Although tropical sprue may cause symptoms
that are similar to celiac disease, the two diseases are not related.)
Celiac disease is common in European countries,
particularly in Ireland, Italy, Sweden, and Austria. In Northern Ireland, for
example, one in every 300 people has celiac disease. In Finland, the prevalence may be as high as one in every 100 persons. Celiac disease also occurs in
North America where the prevalence
has been estimated to be one in every 3000 people. Unfortunately, most population
studies underestimate the prevalence of celiac disease because many individuals who
develop celiac disease have few or no symptoms until later in life. Moreover, a
study suggests that the prevalence of celiac disease
in the United States is similar to that in Europe.
Celiac Disease - Symptoms at Onset of DiseaseQuestion: The symptoms of celiac disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. Symptoms of anemia may include fatigue, malaise, hair loss, palpitations, and more. Treatment for anemia includes treating the underlying cause for the condition. Iron supplements, vitamin B12 injections, and certain medications may also be necessary.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Canker sore is a small ulcer crater in the lining of the mouth. Canker sores are one of the most
common problems that occur in the mouth. Canker sores typically last for
10-14 days and they heal without leaving a scar.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
CT scanning adds X-ray images with the
aid of a computer to generate cross-sectional views of
anatomy.
CT scanning can identify normal and
abnormal structures and be used to guide procedures.
CT scanning is painless.
Iodine-containing contrast material is
sometimes used in CT scanning. Patients with a history
of allergy to iodine or contrast materials should notify
their physicians and radiology staff.
What is a CT scan?
Computerized (or computed) tomography, and often formerly referred to as computerized axial tomography (CAT) scan, is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Computerized tomography is more commonly known by its abbreviated names, CT ...
