While I am a fully licensed physician in Kansas, this communication does not constitute personal medical advice or establish a physician-patient relationship. See your own physician to discuss your particular diagnosis and treatment
CELIAC DISEASE
Other names for this condition: Celiac sprue, non-tropical sprue, gluten-sensitive enteropathy. Condition that is gluten related. This condition can affect 1 and 100 people worldwide. It is estimated that 80% of celiac disease remains undiagnosed. If you have a first-degree relative with this condition you have a 1 and 10 risk of developing this condition yourself. HLA associated T-cell mediated attack on enterocytes, immunological disease. If you have this condition, when you eat a protein found in wheat, rye, and barley, the body mounts an immune response that attacks the small intestine. Nutrients cannot be properly absorbed when this occurs.
Common symptoms in children: Abdominal bloating and pain, diarrhea, constipation, foul-smelling stools, nausea and vomiting, weight loss, delayed onset puberty, failure to thrive, fatigue, headaches, irritability, anxiety, depression, ADHD, learning disabilities, seizures, and lack of muscle coordination.
Common symptoms in adults include abdominal pain, bloating, gas, nausea, vomiting, constipation, diarrhea, depression, cognitive impairment, anxiety, fatigue, headaches, skin rash, arthralgia, menstrual irregularity, mouth ulcers, weight loss, osteomalacia, and neuropathy.
If you have celiac disease, your risk of developing coronary artery disease is double and your risk of developing small bowel cancers is 4 times that of the regular population. Untreated celiac disease can also lead to the development of other disorders including: anemia, thyroid disease, dermatitis herpetiformis, lymphocytic colitis, diabetes mellitus type 1, peripheral neuropathy, ataxia, multiple sclerosis, osteoporosis, infertility, miscarriage, epilepsy, migraines, poor growth, heart disease, gallbladder dysfunction, iron deficiency anemia, lactose intolerance, liver failure, malnutrition, attention deficit hyperactivity, headaches, seizures, dementia, neuropathy, myopathy, pancreatic insufficiency, vitamin and mineral deficiencies, and intestinal cancer.
Diagnosis: Tissue transglutaminase IgA antibody and endomysial IgA antibodies (must be on a gluten-containing diet to trigger this immune response). IgA antibody (if you have IgA deficiency, you can have a false negative tissue transglutaminase and endomysial antibody). Deamidated gliadin peptide can be tested if you are IgA deficient. Intestinal biopsy. If you have dermatitis herpetiformis, the skin biopsy is sufficient for diagnosis. Can order genetic testing as well.
Other lab considerations: CBC, iron studies, vitamin B studies, thyroid function, liver enzymes, calcium, phosphate, vitamin D, copper, and zinc levels.
Other considerations: Bone density test to screen for osteopenia.
Treatment: Gluten-free diet. May need nutritionist referral. Supplementation might include: Fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D. In patients with dermatitis herpetiformis, consider short-term use of dapsone or sulfapyridine to control skin manifestations.
Ongoing research is assessing the effect of modulating CD8 T cells as a seem to be responsible for some of the immune response causing this disorder.
If continued symptoms consider continued gluten ingestion as the cause. Patient may also have an inflammatory bowel disease or another form of colitis. Consider small intestinal bacterial overgrowth, pancreatic insufficiency, and other food intolerances (low FODMAP diet trial might help).
Non-response to vaccines. Study in Turkey in 2010 revealed hepatitis B nonresponse 32.5% in celiac patients versus 14.8% in non-celiac patients. Reference: The response to hepatitis B vaccine: Does not differ in celiac disease? European Journal of gastroenterology and hepatology. 2010 Jul; 22(7): 787-93. Ertem, et. al.
Connection of celiac disease with diabetes type 1. 1 study showed that the prevalence of celiac disease and diabetes mellitus type 1 has increased since 1994 (10.6% versus 6.6%). Salardi, S.; Volta, U.; Zucchini, S.; Fiorini, E.; Maltoni, G.; Vaira, B.; Cicognani, A. Prevalence of Celiac Disease in Children with Type 1 Diabetes Mellitus Increased in the Mid-1990s: An 18-year Longitudinal Study Based on Anti-endomysial Antibodies. J. Pediatr. Gastroenterol. Nutr. 2008, 46, 612–614.
Retinopathy and nephropathy present much earlier in type 1 diabetes patient's that have celiac disease versus those that do not. Diabetes type 1 and celiac disease both share similar HLADQ2 and DQ8 heritability. Unrecognized celiac disease can be associated with elevated homocysteine levels, likely result of folic acid and other B vitamin deficiency. Supplementing with B vitamins can significantly lower homocystine levels and reduce risk of vascular disease. High prevalence of microvascular complications in adults with type 1 diabetes and newly diagnosed celiac disease. Diabetes care. 2011 October; 34 (10): 2158–2163. Leeds, et. al.
Enterovirus infection specifically coxsackie, and rotavirus infection has been linked to increased risk of diabetes mellitus type 1 and celiac disease. Filippi, C.M.; von Herrath, M.G. Viral Trigger for Type 1 Diabetes: Pros and cons. Diabetes 2008, 57, 2863–2871. Kahrs, C.R.; Chuda, K.; Tapia, G.; Stene, L.C.; Mårild, K.; Rasmussen, T.; Rønningen, K.S.; Lundin, K.E.A.; Kramna, L.; Cinek, O.; et al. Enterovirus as trigger of coeliac disease: Nested case-control study within prospective birth cohort. BMJ 2019, 364, l231. Stene, L.C.; Honeyman, M.C.; Hoffenberg, E.; Haas, J.E.; Sokol, R.J.; Emery, L.; Taki, I.; Norris, J.M.; Erlich, H.A.; Eisenbarth, G.S.; et al. Rotavirus Infection Frequency and Risk of Celiac Disease Autoimmunity in Early Childhood: A Longitudinal Study. Am. J. Gastroenterol. 2006, 101, 2333–2340. It is suspected that altered gut permeability and microbiota seem to contribute to the development of both celiac and diabetes mellitus type 1.
With a diagnosis of diabetes type 1 and additional symptoms including: Neuropathy, ataxia, diarrhea, constipation, weight loss, iron deficiency anemia, and decreased low bone density it is useful to test for celiac disease. A 2019 RCT study confirmed that those patients with celiac disease and diabetes type 1 treated with a gluten-free diet have less hypoglycemic episodes and a reduced hemoglobin A1c compared to those on standard diet. Effect of gluten-free diet on metabolic control and anthropometric parameters and type 1 diabetes with subclinical celiac disease: A randomized control trial. Kaur P, Agarwala A, Makharia G, Bhatnagar S, Tandon N. Endocrine Practice. 2020; 26: 660-667.
Connection of vitamin D deficiency and celiac disease. Ingested vitamin D is absorbed in the jejunum and ileum of the small intestine. Celiac disease damages the jejunum of the small intestine.
Connection of celiac disease with mast cell activation syndrome and hereditary alpha tryptasemia syndrome.
Other items of interest possibly related to celiac disease.
Mast cell activation syndrome. Mast cells are produced in the bone marrow and mature in the skin, lungs, GI tract. Mast cells may protect us from parasites, but also contribute to allergic responses by release of histamine. Symptoms that occur are very similar to those that occur with hereditary alpha tryptasemia. Mast cells respond to gliadin peptides that may contribute to a direct role in the onset of celiac disease. Mast cells also directly react against a gluten challenge suggesting that the innate immune system contributes to initiating this immune response to gluten. Observed changes in types and amounts of mediators released by mast cells during the progression of celiac disease indicate that mast cells may vary their activity and response to changes in the environment. International Journal of molecular sciences. 2019 Jul; 20(14):3400. Celiac disease and mast cells. Frossi, et. al.
Hereditary alpha tryptasemia. This disorder can affect up to 6% of the general population per estimates. In this disorder, you have an elevated tryptase level. Symptoms that you might experience include: Skin itching, flushing, hives, anaphylaxis, bloating, abdominal pain, diarrhea, constipation, heartburn, reflux, difficulty swallowing, hypermobile joints, scoliosis, palpitations, blood pressure swings, syncope, anxiety, depression, chronic pain, panic attacks.
I hope this information helps you and your loved ones!
Jason Williams, D.O.