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.
The destruction of the inner
lining of the small intestine in celiac disease is caused by an immunological
(allergic) reaction to gluten in the diet that inflames and destroys the inner lining of the
small intestine. There is evidence that this reaction is partially genetic and
partially inherited. Thus, approximately 10% of the first-degree relatives (parents, siblings
or children) of individuals with celiac disease also will have celiac disease. In
addition, in approximately 30% of fraternal twins and 70% of identical twins,
both twins will have celiac disease. Finally, certain genes have been found to be more common
in individuals with
celiac disease than in those without celiac disease.
Gluten is a family of proteins present in wheat. Some of the proteins that make up gluten (the ones that are dissolved by
alcohol) are called
gliadin. It is the gliadin in
gluten that causes the immunological reaction in celiac disease. The mechanism whereby
gliadin becomes toxic (damaging) is not clear; however, much scientific study is being done, and we are beginning to understand the mechanism.
Proteins, including gliadin, are long chains of amino acids--up to several hundred--attached to each other. Normally during digestion, the digestive enzymes within the small intestine break-up proteins into single amino acids and smaller chains of amino acids. This is necessary because the intestine can only absorb single amino acids or, at most, chains of 3-4 amino acids. Single amino acids and chains of several amino acids do not cause problems for the intestine. It appears, however, that gliadin is not completely broken-up by intestinal enzymes. Several longer chains of amino acids remain intact. Somehow these larger chains enter the cells lining the intestine, perhaps because the cells are abnormally permeable (leaky) to longer chains of amino acids. Some of these longer chains are toxic (damaging) to the intestinal cells. One of the longer chains attaches to an enzyme (tissue transglutaminase) inside the cells. In individuals with celiac disease, the complex of the longer chain of amino acids and tissue transglutaminase sets off an immune reaction that attacks the complex and at the same time damages the intestinal cells.
Barley and rye contain gliadin-like proteins and can cause celiac disease in genetically-predisposed individuals. Oats also contain gliadin-like proteins, but unlike barley and rye, the gliadin-like proteins in oats cause only a mild inflammation and that too in only a few individuals who are predisposed to develop celiac disease. Rice and corn do not cause celiac disease because they do not contain gliadin-like proteins.
What does celiac disease do to the small intestine?
The small intestine has an inner lining of cells that form finger-like
projections called villi. The villi are important because they increase the
urface area available for the absorption of nutrients from
the intestinal lumen into the blood stream. In celiac disease, the inflammation
destroys the villi, causing the inner lining of the small intestine to become
flattened. This loss of villi reduces the number of cells and the surface area available for
absorption of nutrients. The impaired absorption of nutrients is referred to as
malabsorption. The malabsorption of nutrients leads to nutrient deficiencies,
referred to as malnutrition.
The length (amount) of the small intestine affected by the loss of villi
varies from patient to patient, and the length that is involved determines the
severity of signs and symptoms. Thus, individuals whose entire small intestine is
affected by the loss of villi have more severe signs and symptoms of malabsorption
than individuals who have only a part of the small intestine affected. When only a part
of the small intestine is affected, usually the upper small intestine (the
duodenum and jejunum) is affected more than the lower small intestine (the
ileum).
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
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.
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.
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.
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.
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.
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.
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.
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