Celiac Disease Symptoms and Causes Expert Insights

Overview

Also referred to as Celiac Sprue, Celiac Disease is an immune reaction response to consuming gluten, a protein found in foods such as barley, wheat, and rye. Eating gluten with Celiac Disease triggers an immune response in the small intestine. Over time, this reaction to gluten results in damaging the lining of the small intestine and prevent it from absorbing nutrients (malabsorption). The damage leads to bloating, diarrhea, anemia, fatigue, and weight loss.

Malabsorption in children may affect growth and development. Presently, there is no cure for celiac disease. However, following a strict gluten-free diet may help manage symptoms and promote intestinal healing.

Types of Celiac Disease

There are a few different types of Celiac Disease, which are characterized by their clinical presentation, laboratory findings, and histopathological changes in the small intestine. The main types of celiac disease are:

• Classical Celiac Disease: This is the most common type of celiac disease, and it is characterized by gastrointestinal symptoms such as discomfort, diarreah, bloating, and abdominal pain. Classical celiac disease can also cause weight loss and malnutrition. The small intestine biopsy typically shows villous atrophy, crypt hyperplasia, and an increase in intraepithelial lymphocytes.
• Non-classical Celiac Disease: This type of celiac disease is less common and may not cause any gastrointestinal symptoms. Instead, non-classical celiac disease can cause other symptoms such as iron-deficiency anemia, osteoporosis, joint pain, and neurological problems such as headaches and numbness. The small intestine biopsy may show milder histopathological changes than classical celiac disease.
• Latent Celiac Disease or potential Celiac Disease: This is a condition where a person has some of the characteristic features of celiac disease, but without the typical damage to the lining of the small intestine that is seen in classical celiac disease. People with latent celiac disease may have positive blood tests for celiac disease antibodies, but their small intestine biopsy may be normal or show only mild abnormalities.
• Refractory Celiac Disease: This is a rare and severe form of celiac disease where the small intestine damage does not improve despite adherence to a strict gluten-free diet. Refractory celiac disease may be classified into two types: type 1, where there is an increase in intraepithelial lymphocytes, and type 2, where there is a presence of abnormal lymphocytes. Refractory celiac disease requires close monitoring and may require additional treatments, such as immunosuppressive medications.

It is important to understand that all types of celiac disease require strict adherence to a gluten-free diet to prevent further damage to the small intestine and avoid complications. People with celiac disease are recommended to work closely with their healthcare provider and a registered dietitian to ensure that they are meeting their nutritional needs while following a gluten-free diet.

Symptoms of Celiac Disease

Here are the typical symptoms associated with each type of celiac disease:

Classical Celiac Disease: 

• Gastrointestinal symptoms such as diarrhea, abdominal pain, bloating, constipation, and nausea.
• Weight loss, malnutrition, and fatigue. 
• Other possible symptoms include anemia, joint pain, dermatitis herpetiformis (a skin rash), mouth sores, and delayed growth in children.

Non-classical Celiac Disease:

• Iron-deficiency anemia, osteoporosis, and bone fractures.
• Neurological symptoms such as headaches, numbness, and tingling in the hands and feet.
• Joint pain and muscle cramps.
• Dermatitis herpetiformis (a skin rash) and other skin disorders.
• Infertility or recurrent miscarriages.

Silent Celiac Disease:

• No noticeable symptoms or complaints.
• Diagnosis is typically made through blood tests that detect antibodies to gluten or through biopsy of the small intestine.
• Latent celiac disease or potential celiac disease:
• Some of the characteristic features of celiac disease, but without the typical symptoms or small intestine damage seen in classical celiac disease.
• Positive blood tests for celiac disease antibodies, but normal or mildly abnormal small intestine biopsy.

Refractory Celiac Disease:

• Persistent or recurrent symptoms despite adherence to a strict gluten-free diet.
• Abnormal small intestine biopsy findings.
• Possible complications include malabsorption, malnutrition, and an increased risk of intestinal lymphoma.

It is important to remember that celiac disease symptoms can vary greatly from person to person, and some people may not experience any noticeable symptoms at all. A diagnosis of celiac disease should be made by a healthcare provider and confirmed through blood tests and small intestine biopsy.

Causes of Celiac Disease

Most autoimmune diseases, such as celiac disease, are partly inherited. A specific gene mutation passed down through family lines is known to increase one's risk of developing the condition. However, it is not necessary that everyone with the gene mutation develops the condition. Several other factors may act as triggers. Here are some of the causes of celiac disease:

• Physical Stress: It is believed that the condition is triggered by specific physical stress affecting the immune system. According to healthcare providers, celiac disease often appears after a significant physical event such as an illness, surgery, pregnancy, or an intense emotional incident.
• Microorganisms in the Gut: Certain microorganisms existing in the gut are involved in developing the condition.
• Age: Celiac disease is known to occur at any age after eating gluten. As per healthcare providers, the condition is most commonly seen during early childhood (ages 8 and 12 months) and mid-life (ages 40 and 60).

Risk Factors

There are several risk factors for developing celiac disease, including:

• Family history: If you have a family member (parent, sibling, or child) who has celiac disease, you are at a higher risk of developing the condition.
• Genetics: Certain genes are associated with an increased risk of celiac disease. People with the HLA-DQ2 or HLA-DQ8 genes are more likely to develop the condition.
• Age: Celiac disease can develop at any age, but it is more commonly found in people between the ages of 30 and 60.
• Other medical conditions: People with certain autoimmune disorders, such as type 1 diabetes, Down syndrome, and autoimmune thyroid disease, are at a higher risk of developing celiac disease.
• Gastrointestinal infections: Gastrointestinal infections may trigger the onset of celiac disease in people who are genetically predisposed.
• Pregnancy and childbirth: Some women may develop celiac disease during or after pregnancy, possibly due to hormonal changes or changes in the immune system.

It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop celiac disease. Conversely, some people with celiac disease may not have any identifiable risk factors. If you have any questions or concerns about your risk of celiac disease, talk to your healthcare provider.

Frequently Asked Questions

• Diagnosis and Treatment