What is Celiac Disease?

Celiac Disease CD is a disorder of small bowel malabsorption. It is characterized by mucosal inflammation, villous atrophy and crypt hyperplasia, which occur upon exposure to gluten. And clinical improvement upon withdrawal of gluten from the diet. Celiac Disease is also referred to as Celiac Sprue, gluten sensitive enteropathy and non tropical sprue to name a few. It is thought to result from the activation of both a cell- mediated (T-cell) and humoral (B-cell) immune response upon exposure to glutens (prolamins and glutenins) of wheat, oats, barley and rye, in a genetically susceptible person. Genetic susceptibility is associated with certain type ll human leukocyte antigens (HLA). HLA DQ2 is found in up to 95% of CD patients, while most of the remaining patients have HLA DQ8. However, there is only a 30% HLA concordance among siblings, suggesting that other genetic factors are also responsible. More recent evidence suggests that the presence of auto-antibodies to a connective tissue element surrounding smooth muscle called endomysium is highly specific for CD. The target of this autoantibody is now known to be an enzyme called tissue transglutaminase (tTG). This enzyme may play a prominent role in the pathogenesis of CD by modifying gliadin, resulting in a greater proliferative response of gliadin specific T-cells, which contribute to mucosal inflammation and further B-cell activation. CD appears to represent a spectrum of clinical features and presentations. Although "classical" CD (i.e., fully developed gluten-induced villous atrophy and classical features of intestinal malabsorbtion) is most commonly described, it appears that most patients have atypical CD (i.e., fully developed gluten-induces villous atrophy found in the setting of another presentation such as iron deficiency, osteoporosis, short stature, or infertility) or silent CD (i.e., fully developed gluten-induced villous atrophy discovered in an asymptomatic patient by serologic screening or perhaps an endoscopy for another reason.) (Above information from the Evidence Report No. 104) Many patients have little to know symptoms so it is difficult to diagnose and therefore, difficult to know how many actually have CD. The current estimates are 1 in 133 persons. In adults the diagnosis is made on clinical suspicion such as iron deficiency or osteoporosis. Many patience showing lactose intolerance are now tested for Celiac Disease and found that the lactose intolerance is really caused by damage to the villi tips (which digest dairy) that is actually caused by untreated CD that has caused the villi damage. If the patient starts a GF diet the villi can in most cases return to normal and then the lactose intolerance will end. The most serious consequence of CD is malignancy and it is usually in the worst form, T-Cell. Meaning that a gluten free diet is extremely important for a Celiac to follow. The following tests are used to screen for CD. If you or your child are having any of the above symptoms, or if others in the family are showing these symptoms and signs, it is very important that a screening "Celiac Panel" be performed. If CD is found a GF diet MUST be followed to prevent more serious future health risks.

Blood Tests

lgA anti-gliadin antibodies (AGA)
lgA anti-endomysial (EMA)
tTG antibodies, anti-tissue transglutaminase