Celiac Disease (cont.)
Can cancer risk be reduced in celiac disease?Some doctors believe that strict adherence to a gluten free diet can reduce
the risk of cancer in patients with celiac disease, but further
studies are needed to prove this. Until more is known in this area,
patients with celiac disease should adhere strictly to a gluten free diet.
What's new in celiac disease?The way in which gluten and gliadin cause disease appears to be complex. It
does not appear to be simply a matter of an immune response to gliadin. Current
information suggests that gliadin in the diet is altered by tissue
transglutaminase in the small intestine. This altered gliadin is what provokes
the immunologic response that leads to the production of antibodies to tissue
transglutaminase and the inflammation that destroys the villi.
Symptoms of celiac disease can be similar to those of irritable bowel syndrome
(IBS), and the issue often arises if patients with IBS need to be screened for
celiac disease. If they are screened, should they be screened with blood antibody
tests, small intestinal biopsies, or both? One study in particular has addressed
this issue. Approximately 100 patients thought to have diarrhea from IBS were
studied. Among the IBS patients, none had celiac disease-associated antibodies in their
blood, but 30% had the antibodies in juice obtained from within the duodenum.
Twenty-three percent of the patients with IBS had lymphocytes in the lining of
the small intestine just like patients with celiac disease. Finally, 35% of the
IBS patients had the genes that commonly are found in celiac disease. These
interesting findings need to be confirmed by additional studies. If confirmed,
they would suggest that a proportion of patients with IBS may actually have
celiac disease, and that the diagnosis might require small intestinal biopsy and
antibody studies of duodenal juice.
Celiac Disease At a Glance
- 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.
- Patients with celiac disease may develop diarrhea,
steatorrhea, weight loss, flatulence, iron deficiency anemia, 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 also 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; they 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 patients, a gluten free diet will result in
improvements in symptoms within weeks. Many patients report symptom
improvements within 48 hours.
- In children with celiac disease, successful treatment
with gluten free diet can also lead to resumption of growth (with rapid catch
up in height).
- Failure to respond to 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.
- 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 have been 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 for celiac disease patients who develop lymphoma, collagenous
celiac disease, or jejunal ulcers is poor.
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