FAQs: Celiac Disease

What is celiac disease? 
Celiac disease is a genetic disorder affecting children and adults. People with celiac disease are unable to eat foods that contain gluten, which is found in wheat and other grains. In people with celiac disease, gluten sets off an autoimmune reaction that causes the destruction of the villi in the small intestine. People with celiac disease produce antibodies that attack the intestine, causing damage and illness. Finding the cause of this disease is a priority of The University of Maryland Center for Celiac Research.

What are the symptoms of celiac disease?
Symptoms of celiac disease include diarrhea, weight loss, abdominal pain, chronic fatigue, weakness, malnutrition and other gastrointestinal problems. In children, the symptoms may include failure to thrive (an inability to grow and put on weight), irritability, an inability to concentrate, diarrhea and bloating. Further, people affected by celiac disease may experience extra intestinal symptoms that involve many systems and organs including bones (osteoporosis, arthritis, and joint pain), blood (anemia and bleeding), reproductive system (infertility and reoccurring abortion), nervous system (chronic fatigue syndrome, depression, dementia), and behavioral changes.

How common is celiac disease?
Nearly one out of every 133 Americans suffer from celiac disease, according to a new study by the University of Maryland Center for Celiac Research in Baltimore. The research indicates that celiac is twice as common as Crohn’s disease, ulceric colitis and cystic fibrosis combined.

How is celiac diagnosed?
A blood test is now available to screen for the presence of specific antibodies. A biopsy of the intestine (before beginning a gluten free diet) is needed to make a final diagnosis.

What are the long-term effects of celiac disease?
Untreated celiac disease can be life threatening. Celiacs are more likely to be afflicted with problems relating to malabsorption, including osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging, organ disorders (gall bladder, liver, and spleen) and gynecological disorders. Untreated celiac disease has also been linked an increased risk of certain types of cancer, especially intestinal lymphoma.

What is the treatment for celiac disease?
There are no drugs to treat celiac disease and there is no cure. But celiacs can lead normal, healthy lives by following a gluten free diet. This means avoiding all products derived from wheat, rye and barley.

What are the recommended blood tests to diagnose CD?
There is a particular series of blood tests called the ‘Celiac Panel.” These tests measure your immune system’s response to gluten in the food you eat. tTG-IgA or tissue transglutaminase-IgA AGA-IgG or Antigliadin IgG AGA-IgA or Antigliadin IGA Total IGA The presence of tTG antibodies is highly suggestive of CD, while AGA can be elevated also in cases of wheat allergy.

How accurate are the celiac blood tests?
The current diagnostic tests for CD are very accurate, particularly when tTG and anti-endomysial antibodies are elevated. The isolated presence of anti-gliadin antibodies does not necessarily imply that the subject is affected by CD, with the exception of children under the age 2 in which tTG and EMA may not be present

Are the villi permanently damaged in a patient with celiac disease and how long does it take for the villi to return to normal?
The villi are not permanently damaged. The intestine is an organ, which renews itself every three days. Therefore, if the damage is exclusively due to CD, the villi will be reformed once on a gluten-free diet. The time for the villa to return to normal varies among individuals.

What is the meaning of HLA DQ2/DQ8?
As an autoimmune disease, CD is the consequence of the interplay between genes and the environment (gluten). We don’t know all the necessary genes to develop CD; however, HLA DQ2 and/or DQ8 are absolutely necessary to develop the disease. Since 1/3 of the general population also have these genes, the presence of DQ2 or DQ8 does not imply that the person will develop CD, rather, that they have a genetic compatibility with CD. Conversely, the absence of DQ2/DQ8 almost certainly rules out CD.

Is it necessary to have an intestinal biopsy to confirm the diagnosis of celiac disease?
Currently, the intestinal biopsy is the gold standard for the diagnosis of celiac disease, and therefore is considered essential.

Can a person with celiac disease on gluten-free diet give blood?
Yes, a person with celiac disease can donate blood.

Can a person with celiac disease drink wine?
Yes, wine is made from grapes. Conversely, beer is made from grains and cannot be consumed by a celiac.

Can I outgrow celiac disease?
If you are a biopsy proven celiac, you will not outgrow the disease since celiac disease is now considered to be an autoimmune disorder like diabetes and rheumatoid arthritis.

Do I need to repeat the biopsy once on a gluten-free diet?
If you are diagnosed based on positive serology and biopsy, and your symptoms improve once on a gluten-free diet, you do not need a follow-up biopsy.

Is celiac disease a food allergy?
No, celiac disease is not a food allergy; rather it is an autoimmune disease. Food allergies, including wheat allergy, are conditions that people can grow out of. This is not the case with CD.

Copied from the Celiac Center for Research, University of MD, Baltimore, MD. For more information, visit their website at www.celiaccenter.org

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