Commonly referred to as wheat allergy, celiac disease is not an allergic disorder; rather it is actually intolerance to gluten, a protein in wheat. It is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy. Celiac disease occurs in people who have a genetic susceptibility. It was considered a north European disease initially but now it has a high prevalence in all the continents. In north- India it affects 1 in 200-300 individuals, similar to its prevalence in Europe.
Celiac disease is primarily a digestive condition triggered by consumption of the protein gluten resulting in an immune reaction in the small intestine, which leads to inability to absorb certain nutrients from food. Eventually, decreased absorption of nutrients (malabsorption) causes vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment. The decreased nutrient absorption that occurs in celiac disease is especially serious in children, who need proper nutrition to develop and grow.
Unfortunately awareness about this disease is very poor among the population and even among doctors. Celiac disease is seen primarily by pediatricians and gastroenterologists but increasingly endocrinologists, hematologists and internists are getting patients of this malady. Signs and symptoms There are no typical signs and symptoms of celiac disease. In children it manifests early with diarrhea which starts when the child is weaned off milk and started on solid diet. Another common manifestation in children is stunting of growth or failure to gain height and weight .
School performance may get affected in some children. In India celiac disease has been recognized in children for the last over 40 years but it has attracted the attention of those caring for adults only in the last decade. Most adult people with the disease have general complaints, such as intermittent diarrhea, abdominal pain and bloating. Sometimes people with celiac disease may have no gastrointestinal symptoms at all. In fact half of the adult celiac disease patients coming to PGI do not have any abdominal symptoms.
The most common non –gastrointestinal symptom is iron deficiency anemia followed by weight loss. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, parasite infections, skin disorders or bone disease. Celiac disease may also present itself in less obvious ways, including irritability or depression, joint pains, muscle cramps, mouth sores, dental and bone disorders (such as osteoporosis), and tingling in the legs and feet (neuropathy). When to seek medical advice
If you notice or experience any of the signs or symptoms common to celiac disease, see your doctor. If someone in your family is known to have celiac disease, you may need to be tested. Starting the process will help you avoid complications associated with the disease, such as osteoporosis, anemia and certain types of cancer. Seek medical attention for a child who is pale, irritable, fails to grow and who has foul smelling stools. Many other conditions can cause these same signs and symptoms, so it’s important to talk to your doctor before trying a gluten-free diet.
Left untreated, celiac disease can lead to several complications: ? Malnutrition. Untreated celiac disease can lead to malabsorption, which in turn can lead to malnutrition. This occurs in spite of what appears to be an adequate diet. Because vital nutrients are lost in the stool rather than absorbed in the bloodstream, malabsorption can cause a deficiency in vitamins A, B-12, D, E and K, folate and iron, resulting in anemia and weight loss. Malnutrition can cause stunted growth in children and delay their development.?
Loss of calcium and bone density. With continued loss of fat in the stool, calcium and vitamin D may be lost in excessive amounts. This may result in a bone disorder called osteomalacia, a softening of the bone also known as rickets in children, and loss of bone density (osteoporosis). ?Cancer. People with celiac disease who don’t maintain a gluten-free diet also have a greater chance of getting one of several forms of cancer, especially intestinal lymphoma. ?Other complications.
Celiac disease has been linked to a number of autoimmune diseases kike thyroid disorders, autoimmune hepatitis and infertility, among others. Diagnosis Patients with celiac disease have high titres of certain antibodies, to certain proteins related to gluten, A blood test can detect high levels of these antibodies . Commonly used tests are anti-tissue glutaminase antibodies ,anti-gliadin antibodies and endomyseal antibodies. To confirm the diagnosis, a biopsy is taken from the small intestine through an endoscope, which is examined under the microscope. Treatment.
The treatment is simple though not very easy to follow. It involves total avoidance of wheat and wheat products and nutritional supplementation. North- Indian diet is very heavily dependent on wheat, so it creates a problem, especially in children. Wheat products are totally prohibited and they include atta, maida, suji, commercially available biscuits, namkeen, noodles, cakes and pastries, ice-creams and other snacks. Rye and barley are also prohibited. Thus gluten-free diet consists of maize, rice, rice flour, maize-flour, Soya-flour, besan and a mixture of these flours.
All vegetables, fruits, eggs and all meat products are permitted. Certain shops in big cities market gluten-free biscuits and snacks . Indeed it is difficult for mothers to plan recipes for school-tiffin for their children. However a consultation with a dietician can easily solve this problem. Apart from gluten-free diet, which has to be continued life long, patients with celiac disease need supplements like iron, Vitamin B, and calcium. If adequately treated, patients with celiac disease will lead a healthy and normal life.