Symptoms Of Celiac Disease In Adults
Celiac disease is an inflammatory disease. It is triggered by a misdirected immune reaction (autoimmune reaction) on gluten protein, which is found in many cereal cultivars.
Affected individuals usually suffer from severe diarrhea and stomach aches when eating gluten-containing foods. Until now, the therapy is mainly limited to a life-long gluten-free diet.
Celiac disease (gluten sensitive enteropathy) is an autoimmune inflammatory disease. The body reacts with a reaction of the immune system to the gluten protein gluten. Gluten is found in most common grain varieties.
Diarrhea, flatulence, abdominal pain
When people with celiac disease receive gluten-containing food, they experience typical symptoms. These include stomach pain, flatulence and diarrhea.
In addition to these short-term symptoms, long-term symptoms occur as mucous membrane of the intestine is damaged by the inflammation, so that all food components can be absorbed into the body (malabsorption). This can lead to severe deficiency. In some patients the gluten intolerance with atypical symptoms is shown on the skin. It is often recognized late.
Long way to diagnosis
A celiac diagnosis is not always easy because not all patients suffer from the typical symptoms. Up to 90 percent of those affected complain of untypical symptoms, which are not interpreted correctly for many years.
It takes an average of four years for the diagnosis to be made. Considering that the disease can be treated very successfully with a gluten-free celiac diet.
In addition, a continued gluten-rich diet in celiac disease increases the risk of further autoimmune diseases and even certain types of cancer (intestinal lymphoma, adenocarcinoma of the intestine). Therefore, a celiac disease should be diagnosed as early as possible. The detection of celiac disease is now very simple. For this purpose, antibodies are determined in the blood and sometimes a tissue sample is taken from the small intestine.
What Are The Symptoms Of Celiac Disease?
Typical celiac symptoms are fatty diarrhea, flatulence and stomach cramps that occur after a gluten-rich meal. However, not all people with gluten intolerance have such symptoms, which makes the diagnosis more difficult. Thus, some patients developed exclusively celiac symptoms that are not related to the intestine. Others are even symptom-free.
Symptomatic Celiac disease Symptoms
In the case of symptomatic (classical) celiac disease, the affected persons have above all gluten allergy symptoms, which relate to the digestion. After a gluten-rich diet, fatty diarrhea, flatulence and abdominal pain occur.
If these celiac symptoms persist for an extended period of time, the patient do not only löse weight, also loses protein which can cause protein deficiency.
Through this, body can hold the water worse in the vessels. Instead, it accumulates in the tissue and edema is formed. However, celiac disease is rarely diagnosed due to gastrointestinal problems. Patients are increasingly affected by atypical celiac symptoms.
All celiac symptoms that are not directly related to the intestinal function are summarised as atypical. For example, about 40 percent of those affected lack the typical gastrointestinal discomfort caused by a gluten. Symptoms can affect the entire body and also manifest in mental discomfort.
Many of the physical ailments can be traced back to a vitamin or trace element deficiency. These deficiencies arise because, due to the inflammatory processes in the intestines, these substances cannot be absorbed sufficiently in the blood (malabsorption) despite sufficient food intake.
Among the most common atypical signs of the disease are:
- Liver disease with slightly elevated liver values
- Skin inflammation with itching reddish raised blisters
- Anemia, tongue burning
- Osteoporosis, muscle weakness, muscle cramps, bone pain (due to calcium deficiency)
- Bleeding, for example in the skin (by vitamin K-magel)
- Night blindness (due to vitamin A deficiency)
- Thyroid dysfunction
- Inflammation of the renal corpuscles (IgA nephropathy)
- Joint pain
- Mood swings
- Epileptic seizures (temporal lobe epilepsy)
- Motion coordination disorder (cerebellar ataxia)
- Nervous disorders (peripheral neuropathy)
Celiac Symptoms in Children
Even with a toddler, a gluten intolerance can cause symptoms of a digestive disorder. These can be expressed by an exaggerated belly, voluminous, evil-smelling diarrhea or in a food refusal.
Some children fall asleep at the pediatrician during preventive examinations because they no longer grow properly or delay their puberty. Iron deficiency is also a typical symptom of gluten intolerance in children. Signs of celiac disease can also be changes in the personality or behavior of the child. Then, children are strikingly vague, displeased, or apathetic. Symptoms of celiac disease occur frequently in children at the end of the first year, approximately three to six months after the first gluten-containing meal.
Subclinical Celiac Disease Symptoms
Subclinical patients are diagnosed with gluten intolerance but without celiac symptoms. In this group the typical antibodies can be detected in the blood. Also the tissue sample (biopsy) of the small intestine mucosa shows the changes typical of celiac disease.
Nevertheless, people with subclinical celiac disease have no complaints. Therefore, a gluten-free diet has no positive effect. The celiac disease is usually found in them in the context of a screening test, which is carried out when close relatives are affected by celiac disease. Celiac disease with subclinical symptoms can manifest itself in unspecific symptoms such as general fatigue. These patients benefit partly from a gluten-free diet.
Potential Celiac Disease Symptoms
In a potential celiac disease, disease-specific antibodies can be detected in the blood. However, a small bowel (biopsy) shows an inconspicuous finding.
Refractory Celiac Disease Symptoms
The refractory celiac disease is a very rare form which occurs in about 1.5 percent of celiac patients. In the case of refractory celiac disease, the typical signs of gluten intolerance can be found in the blood and in a small intestine. However, the affected person can not positively influence the disease with a strict gluten-free diet.
A refractory celiac is referred to when the symptoms do not subside during a twelve-month gluten-free diet, or typical or atypical celiac symptoms reappear after an improvement.
Complications By Gluten Intolerance
Patients who have celiac symptoms for a long period of time may develop episodes. They can develop a temporary or permanent lactose intolerance (lactose intolerance), because the intestinal mucosa forms too little milk-clearing enzymes due to the inflammation.
As a late complication of celiac disease, even cancer can occur in the small intestine (adenocarcinoma and intestinal lymphoma). Also the connective tissue in the large intestine can ignite (collagen colitis), if severe celiac symptoms exist.
Celiac Disease Causes and Risk Factors
The mechanisms involved in celiac disease in the body have already been investigated relatively well. However, it has not yet been possible to establish why celiac disease ultimately occurs. Among other things, genetic factors contribute to the development. Since not all people with an appropriate predisposition actually suffer from celiac disease, there must also be other influencing factors. It is assumed that nutrition and other environmental factors also play a role.
What is Celiac Disease and How Does It Develop?
Celiac disease is an autoimmune disease that leads to inflammation in the small intestine. Affected persons can not tolerate the gluten protein or its constituent gliadin. Gluten is contained in many cereals: wheat, rye, barley, spelled and green core. Small quantities are also found in oats. In healthy people, gluten is split by the enzyme tissue transglutaminase (TG2) in the intestinal mucosa.
When celiac patients receive gluten-containing foods, IgA antibodies form against the tissue transglutaminase and against the protein gliadin. The body falsely detects gluten as harmful and attacks with its antibodies to intestinal mucosa where surface the tissue transglutaminase and gliadin sit. This immune reaction causes inflammation of the intestinal mucosa.
Over time the mucous membrane is so severely damaged by the chronic inflammation that the food can not be absorbed into the blood normally (malabsorption). In healthy persons the intestinal mucous membrane is wrinkled, it forms so-called villi. This structure enlarges the surface of the intestine. This has the advantage that the food ingredients can quickly pass from the intestine to the blood.
In celiac disease, the autoantibodies destroy these protuberances (villous atrophy). This reduces the surface area for nutrient uptake. If the disease persists for a long time, the malabsorption can cause severe deficiency.
Gluten: Allergy or Autoimmune Disease?
Sometimes celiac disease is also called gluten allergy. However, experts do not agree on whether an allergy or an autoimmune disease is actually associated with gluten intolerance. In fact, the gluten allergy has both elements of an allergy, as well as an autoimmune disease.
An allergy is generally an excessive reaction of the immune system to actually harmless substances. This is the case in celiac disease, since the immune system reacts to the genuinely harmless cereal protein gluten with an overwhelming immune response.
On the other hand, certain antibodies (immunoglobulins) are also formed in the case of celiac disease against the body-borne enzyme tissue transglutaminase. According to current knowledge, celiac disease is most likely to be described as a mixed form of allergy and autoimmune disease. However, the term gluten allergy has not been applied in science and should therefore be avoided.
In celiac disease, hereditary factors are very likely to play a decisive role. Approximately 90 percent of those affected have a certain surface protein on the immune cells (especially HLA-DQ-2 but also HLA-DQ-8). This protein binds fragments of gluten and is involved in the inflammatory immune reaction.
As it is inherited, family members of those affected have a risk of celiac disease about ten to fifteen times higher. Other autoimmune diseases such as a type of diabetes mellitus (type 1 diabetes) or autoimmune thyroid infections are also associated with this surface protein. However, about 30 to 40 percent of healthy people also have this surface protein. Therefore, environmental factors also have an important influence on the development of the disease.
Nutrition and Environment
People who have already come into contact with gluten-rich food as newborns are more likely to develop celiac disease. Baby food – especially when the child has close relatives with gluten intolerance – should consist of mother’s milk or gluten-free food.
Infections with intestinal viruses or a change in the bacterial intestinal flora are also discussed as possible risk factors. In addition, psychosocial factors should contribute to the formation of celiac disease.
Related To Other Diseases
Celiac disease occurs together with other diseases. People with Turner syndrome, Down syndrome, IgA deficiency, type 1 diabetes and other autoimmune diseases such as autoimmune thyroiditis or autoimmune hepatitis are more likely to develop gluten intolerance. Why celiac disease occurs with these diseases is still unclear.
Treatment Of Celiac Disease
If a person suffers from celiac disease, the illness accompanies him throughout his life. So far, there is no healing therapy. Sufferers have to feed on gluten-free life. Under consistent gluten nutrition, the complaints are fortunately almost completely back.
As part of the celiac disease treatment, existing deficiency conditions are also compensated until the attacked intestine has normalized. There are currently numerous scientific projects working on active substances or vaccination against the gluten. Until now, however, there is no drug on the market that can make a gluten-free celiac diet superfluous.
Celiac Disease Treatment: Diet
Newly diagnosed celiac disease patients initially feel extremely restricted in their diet. In fact, they have to remove a variety of food from the diet. However, the more intensively affected persons are informed about the gluten-free diet, the more opportunities they find themselves gluten-free and yet varied.
The following tips will help you to find out which cereals and foods you can avoid if you are allergic to gluten and which you can safely take with you:
Strictly avoid – gluten-containing grains
Patients with celiac disease must have a so-called gluten-free diet (GFD) for a lifetime
The following cereal varieties and products in which they are contained should be avoided completely and permanently in case of a gluten intolerance:
- Unripe spelt grain
- Emmer Kamut
- Sometimes oats (does not cause any discomfort for all concerned)
Patients with gluten intolerance must gradually learn which products contain gluten. As a matter of principle, the manufacturers have been obliged since 2005 to label gluten-containing foodstuffs according to their allergenic labeling requirements.
Gluten-containing ingredients such as wheat must appear on the list of ingredients. However, the term “gluten” itself need not be mentioned. For people with celiac disease, it is necessary to know which ingredients contain gluten. A food is then gluten-free if it contains a maximum of 20 ppm (2 mg per 100g) of gluten.
The above-mentioned gluten cereals are processed in a variety of food products. This means that these foods must be completely avoided. Gluten is almost always included in the following products:
- Bread and other baked goods
- Cereals and other breakfast cereals
- Breaded meat
- Malt Coffee
- Soy sauce (There is also gluten-free soy sauce)
Fortunately, there are also some cereal varieties that do not contain glüten. Therefore, these are harmles for the people with celiac disease.
These are at the following:
- Teff (Dwarf millet)
The following foods do not naturally contain gluten and can be eaten without hesitation (unless they contain gluten additives):
- All types of fruit and vegetables
- Meat, poultry, fish, seafood
- Legumes, such as soya
- Eggs, milk, dairy products, butter, margarine
- Jams, honey
- Sugar, salt, herbs
- Nuts and Oils
- Water and juices
- Wine and Champagne
- Coffee and tea
Celiac disease and Babies
If a pregnant woman suffers from celiac disease or if there are relatives with this condition in her family, she should breast-feed her child as long as possible. Mothers milk has a protective (protective) effect on celiac disease. Studies from the USA and Sweden also suggest that small amounts of gluten-containing foods in the middle infant can also have a protective effect.
According to the study, the administration of small amounts of gluten-containing foods in the fifth to seventh months of life has a favorable effect. This means that children who were fed gluten-containing food in this age of life later suffered less frequently from celiac disease. However, children who have previously been exposed to gluten seem to be at increased risk of celiac disease.
In case of suspected celiac disease in childhood, it should be immediately checked whether a gluten intolerance is responsible for the complaints.
Otherwise, in the case of an untraceable and untreated celiac disease, severe developmental disorders (“disturbances of growth”) are threatened by the lack of vitamins, trace elements and nutrients.
Celiac Disease Prognosis
Celiac disease is an illness that accompanies the affected person throughout their lives. Under a gluten diet, however, the symptoms usually disappear completely. However, a gluten-free diet poses major problems for many people, as it involves a massive cut into the past dietary habits.
Celiac disease patients with whom the disease exists for a long time have an increased risk of certain cancer diseases in the gastrointestinal tract (intestinal T-cell lymphoma, adenocarcinoma). In addition, inflammation in the intestine can lead to serious deficiencies of vitamins, trace elements and other nutrients, and other disturbances of digestion, such as lactose intolerance.
The intestinal inflammation leads to a deficiency of the milk sugar splitting enzyme lactase, which normally in the area of the intestinal mucosa of the small intestine fulfills its function. As a result, the lactose can no longer be digested, and often a lactose occurs at least temporarily. All these diseases are mostly irrelevant for people who know about their disease and can protect themselves with a gluten diet.
However, there are a large number of people who have not yet been diagnosed with celiac disease. Thanks to new possibilities of investigation, the disease can now be easily diagnosed. Testing should be mainly people with typical complaints, associated companion diseases and relatives with celiac disease.