Celiac disease is an autoimmune disorder that interferes with a person's ability to digest food. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes it as both a disease of malabsorption and an abnormal immune reaction to gluten.
According to the two organizations that promote celiac disease awareness and advocate on behalf of patients, underdiagnosis of the condition is a significant problem. The Celiac Disease Foundation reports that more than 3 million Americans have been diagnosed with celiac disease, but an estimated 2.5 million more are affected and have not received a diagnosis. The National Foundation for Celiac Awareness says that the disease affects 1 of every 141 U.S. residents.
In recent years, advocacy organizations have worked to build greater awareness and diagnosis of celiac disease by declaring May as Celiac Disease Awareness Month. Because some patients with the disease do not experience typical symptoms, they don't seek diagnosis and treatment and are therefore at risk for other health problems. May is an opportune time to query patients about a family history of celiac disease or a personal history of symptoms that suggest presence of the disease.
Symptoms of celiac disease can be quite variable. Patients may notice abnormalities in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include abdominal bloating and pain; chronic diarrhea; vomiting; constipation; pale, foul-smelling or fatty stool; and weight loss.
Adults are less likely to have digestive symptoms and may instead have one or more of the following: unexplained iron deficiency anemia; fatigue; bone or joint pain; arthritis; bone loss or osteoporosis; depression or anxiety; tingling or numbness in the hands and feet; seizures; menstrual irregularities; infertility or recurrent miscarriage; canker sores; or dermatitis herpetiformis.
People with celiac disease may have no symptoms yet are at risk for developing complications of the disease. Long-term complications include malnutrition, liver diseases and cancers of the intestine.
About 95% of people with celiac disease have the HLA-DQ2 gene, reports the National Foundation for Celiac Awareness. Most of the remaining 5% have the HLA-DQ8 gene. Genetic testing can determine whether one or both of these genes are present. Having one of these genes proves risk; it is not diagnostic for celiac disease. A positive genetic test should be followed up with a celiac blood panel consisting of serological tests to detect antibodies to endomysium, transglutaminase and deamidated gliadin.
Points to Remember
The NIDDK offers the following points to remember:
• People with celiac disease cannot tolerate gluten, a protein in wheat, rye and barley.
• Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
• Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia and cancer.
• A person with celiac disease may or may not have symptoms.
• Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
For More Information
National Institute of Diabetes and Digestive and Kidney Diseases celiac disease information page:
Celiac Disease Foundation: http://celiac.org
National Foundation for Celiac Awareness: http://celiaccentral.org
Prepared by the Nurse Practitioner Perspective editorial staff