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Diagnosing Celiac Disease

By J. David Schmidt, MD

UPDATED 10/9/2018

 
Celiac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. The consumption of gluten aggravates the small intestine creating chronic inflammation. Gluten is found primarily in wheat, barley, rye, and in foods such as pizza, pasta, cereal, as well as some unlikely places like salad dressings, ketchup, BBQ sauces, supplements and medications.

If left untreated, people can develop further complications such as anemia, vitamin deficiencies, osteoporosis and cancer. For celiac patients, the villi—tiny finger-like projections in the small bowel—get worn down or blunted and become ineffective in absorbing nutrients. A lack of certain nutrients can have detrimental effects; for example, a lack of iron can result in anemia or a deficiency in vitamin D can lead to osteoporosis or even neurological dysfunction.

When a celiac patient is exposed to gluten, it is damaging the body, long term. That is why it is so important to diagnose as early as possible.  Some of the outward symptoms of someone with celiac may include diarrhea, bloating, upset stomach, fatigue, headaches and constipation, among others. The disease can be asymptomatic as well. The symptoms can also overlap with or mimic other conditions such as lactose intolerance or irritable bowel syndrome.  It is estimated that 83% of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions.

Testing for Celiac 

Testing for celiac involves two blood tests that measure antibodies, the immune response to gluten. These tests are over 95% accurate. If test results are positive, an upper endoscopy procedure (EGD) is then performed to secure a small biopsy of the small intestine to confirm the diagnosis and determine the extent of damage/severity of the disease. An accurate diagnosis is very important as patients need to change their eating habits for the rest of their lives.

It is possible that if one person in the family has celiac disease, there will be other relatives who also have it or who have been diagnosed with another autoimmune disorder such as Rheumatoid Arthritis, Type 1 Diabetes, or a thyroid condition. Genetically, up to 40% of Caucasians have one or both genes that are associated with celiac disease.

When I am talking with the patient in the office, I listen for clues, such as a family history of a sensitive stomach or food allergies or other autoimmune diseases. This knowledge helps me sift through the symptoms that, at first, may seem like Irritable Bowel Syndrome, or ulcers, Crohn’s disease or even gallbladder problems.  Following up on this information can help get to the correct diagnosis quickly.

Once diagnosed, I reassure my patients that living a gluten-free lifestyle is not nearly as tricky as it used to be. Now grocery stores and restaurant menus abound with gluten-free options. Plus plenty of naturally occurring gluten free foods offer healthy options, such as vegetable, fruits and meat.

Learning to eat at home, school and at restaurants can be a challenge, but the evidence is clear. Celiac patients must be vigilant about their diet and treatment. Regardless of whether gluten seems to upset your stomach or not, it is important to follow a gluten-free diet if you are diagnosed with celiac disease. Your health is too important and there are many good choices available to help you succeed. Make the right choices for your good health. A lot is at stake!

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