Celiac Disease | Causes | Treatment - Dr. Arun Aggarwal
What is celiac disease? — Celiac disease is a condition that impairs your body's ability to break down certain foods. People who have the disease get sick if they eat bread, pasta, pizza, and cereal. These foods and others contain a protein called "gluten." Gluten damages the intestines of people with celiac disease. As a result, their bodies can't absorb nutrients from food.
CELIAC DISEASE CAUSES
Celiac disease occurs as a result of a child's genetics and exposure to a trigger. A child who develops celiac disease probably inherits the risk from one or both parents and then develops the disease when exposed to the dietary trigger, gluten.
Celiac disease is different from a wheat allergy. Allergies occur when different parts of the immune system are activated by wheat, causing allergic symptoms such as hives and wheezing.
What are the symptoms of celiac disease? — Some people with celiac disease have no symptoms. When symptoms do occur, they can include:
●Pain in the belly
●Diarrhea
●Bowel movements that are oily and float
●Weight loss
●Feeling bloated, or too full all the time
●Low appetite
●Bad gas
●Itchy skin rashes
●Invisible symptoms, such as weak bones or low iron levels
●Slow growth in children
Is there a test for celiac disease? — Pediatric Gastroenterologist uses more than one test to diagnose celiac disease:
●Blood test – A blood test looks for antibodies that some people make after eating gluten. People who have celiac disease have lots of these proteins, called antibodies. You should ideally be on a gluten-containing diet for several weeks before getting the blood test. If you are on a gluten-free diet, your gastroenterologist might do other blood tests to see if you are genetically likely to have celiac disease.
●Biopsy – To do a biopsy, the Pediatric Gastroenterologist will put a thin tube with a tiny camera down your throat. When the tube is in your small intestine, he or she will take a small sample of tissue. That way he or she can look at the tissue under a microscope and see if eating gluten has damaged the intestine.
High-risk groups — Testing is recommended for certain children (older than three years) who are at increased risk of developing celiac disease, even if the child has no symptoms.
●First-degree relatives (children, siblings) of a person with celiac disease
●Down syndrome
●Type 1 diabetes
●Selective IgA deficiency
●Turner syndrome
●Williams syndrome
●Autoimmune thyroiditis
How is celiac disease treated? — The best treatment is to stop eating gluten completely. This might be hard to do at first. You will need to avoid rye, wheat, barley, and maybe oats. These ingredients appear in many common foods, including:
●Bread, pasta, pastries, and cereal
●Many sauces, spreads, and condiments
●Beers, ales, lagers, and malt vinegar
Foods that do not contain gluten (and are fine to eat) include:
●Rice, corn, potatoes, buckwheat, and soybeans
●Fruits and vegetables
●Flours and other products made from these ingredients that have a label on them that says "gluten-free"
Your doctor might also prescribe vitamins to make up for nutrients that you have not been getting from food.
Who should be on a gluten-free diet? — People with a condition called celiac disease should be on a gluten-free diet.
If you think you have celiac disease, don't start a gluten-free diet until after you are tested for the disease. That's because what you eat can affect your test results.
More and more, though, people without celiac disease are eating a gluten-free diet. They might have heard that this diet can help them lose weight or feel better. It's true that a gluten-free diet may be healthy. But it also sometimes keeps people from getting all the nutrition they need. If you are thinking about being on a gluten-free diet, ask your doctor if it's a good choice for you.
Is a strict gluten-free diet really necessary? — A completely gluten-free diet is the only treatment for celiac disease.
Children who do not have symptoms of celiac disease often find it hard to follow a strict gluten-free diet. However, most experts recommend a strict gluten-free diet for all children with celiac disease, whether or not the child has symptoms, for the following reasons:
●Some children with celiac disease develop vitamin or nutrient deficiencies, even if they feel well. If untreated, these deficiencies can cause problems (such as anemia due to iron deficiency or bone loss due to vitamin D deficiency). People with celiac disease who do not follow a strict gluten-free diet are more likely to have certain health problems as adults, including osteoporosis (thinning of bones), infertility, having babies with lower birth weight, and possibly certain types of cancer.
●Strictly following a gluten-free diet usually helps improve a child's energy and sense of well-being even if the child does not have obvious symptoms.
Monitoring during treatment — after starting a gluten-free diet, most children begin to feel better within a few weeks.
About six months after starting a gluten-free diet, the child's doctor might repeat a blood test to test the TTG antibody levels. The antibody level should be lower as the child improves and continues to avoid gluten. For most children the antibody levels return to normal quickly; however, for some children, it may take longer for the antibody level to normalize.
A repeat biopsy of the small intestine is not usually necessary if the child's symptoms improve and the antibody levels decrease once a gluten-free diet is started. A repeat biopsy or other tests may be recommended if symptoms do not improve or if antibody levels remain elevated.
LIFE WITH CELIAC DISEASE
A gluten-free diet will require changes for the entire family. Talking to an experienced healthcare provider or dietitian can help parents and children make the needed adjustments to a gluten-free lifestyle. While there is an abundance of information on the internet that can provide very useful information, community-based support groups have been found to have a significant positive effect on quality of life. The community-based support groups offer the family important information and networking resources to navigate through schools, camps, etc.
Parents of children who are newly diagnosed with celiac disease will need to speak to their child's teacher or daycare provider about the condition, what foods are safe, and what to do in case of inadvertent exposure to gluten.
Other common concerns include what to do when eating out, traveling, at parties, at school, and at sleep-away camp.
Celiac disease is a lifelong condition. There is no cure for celiac disease, although avoiding gluten probably prevents all complications of celiac disease.
Because children with celiac disease might have an increased risk of certain infections, a vaccination is recommended to reduce the risk of pneumococcal infections (like pneumonia).
As a general rule, there are six key elements in the management of patients with celiac disease:
●Consultation with a skilled dietitian
●Education about the disease
●Lifelong adherence to a gluten-free diet
●Identification and treatment of nutritional deficiencies
●Access to an advocacy group
●Continuous long-term follow-up by a multidisciplinary team
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