Celiac Disease (cont.)
Bhupinder Anand, MD
In this Article
What are the signs and symptoms of celiac disease?
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The signs and symptoms of celiac disease vary depending on the degree of malabsorption, and ranges from no symptoms, few or mild signs and symptoms, to 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 of malabsorption
The three major categories of dietary nutrients are carbohydrates, proteins, and fat. Absorption of all of these nutrients can be reduced in celiac disease; however, fat is the most commonly and severely affected nutrient. Most of the gastrointestinal symptoms and signs of celiac disease are due to the inadequate absorption of fat (fat malabsorption). Gastrointestinal symptoms of fat malabsorption include diarrhea, malodorous flatulence (foul smelling gas), abdominal bloating, and increased amounts of fat in the stool (steatorrhea). The unabsorbed fat is broken down by intestinal bacteria into fatty acids, and these fatty acids promote secretion of water into the intestine, resulting in diarrhea. Fatty stools typically are large in volume, malodorous (foul smelling), greasy, light tan or light grey in color, and tend to float in the toilet bowl. Oil droplets (undigested fat) also may be seen floating on top of the water.
Loss of intestinal villi also causes malabsorption of carbohydrates, particularly the sugar lactose. Lactose is the primary sugar in milk. Lactose is made up of two smaller sugars, glucose and galactose. In order for lactose to be absorbed from the intestine and into the body, it must first be split into glucose and galactose. The glucose and galactose can then be absorbed by the cells lining the small intestine. The enzyme that splits lactose into glucose and galactose is called lactase, and it is located on the surface of the small intestinal villi. In celiac disease the intestinal villi along with the lactase enzymes on their surface are destroyed, leading to the malabsorption of lactose.
The signs and symptoms of malabsorption of lactose are particularly prominent in individuals with celiac disease who have an underlying lactose intolerance, a genetically determined reduction in the activity of lactase. The symptoms of lactose malabsorption (diarrhea, excessive flatulence [passing gas], abdominal pain and abdominal bloating or distension) occur because unabsorbed lactose passes through the small intestine and into the colon. In the colon, the normal colony of bacteria contain lactase and are able to split the lactose, and utilize the resulting glucose and galactose for their own purposes. Unfortunately, when they split the lactose into glucose and galactose, the bacteria also release gas (hydrogen and /or methane). A proportion of the gas is expelled and is responsible for the increased flatus (passing gas) that may occur in celiac disease. Increased gas mixed in the stool is responsible for the stools to float in the toilet bowl.
Not all of the lactose that reaches the colon is split and used by the colonic bacteria. The unsplit lactose that reaches the colon causes water to be drawn into the colon (by osmosis). This promotes diarrhea.
2. Signs and symptoms of malnutrition and vitamin or mineral deficiencies
Symptoms of malnutrition and vitamin or mineral deficiencies include: weight loss, fluid retention, anemia, osteoporosis, bruising easily, peripheral neuropathy (nerve damage), infertility, and muscle weakness.
Reviewed by Bhupinder Anand, MD on 6/28/2011
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