Brief Overview: Celiac Disease is an autoimmune condition. With Celiac Disease, when gluten is ingested, the body develops an immune response that attacks and damages the small intestine.
Prevalence: According to UpToDate, “The estimated global prevalence of celiac disease based on serologic studies is approximately 1 percent.”
Etiology: Typically, celiac disease has a genetic predisposition. Environmental factors are also thought to cause Celiac Disease. It is triggered by consuming gluten.
Risk Factors:
- Family history of Celiac disease in first- and second-degree relatives
- Type 1 Diabetes
- Autoimmune thyroiditis
- Down and Turner Syndromes
- Pulmonary hemosiderosis
- Several other autoimmune diseases also increase risk for Celiac Disease
Commonly Associated Conditions:
- Selective IgA deficiency
- Iron deficiency anemia
- Osteoporosis
- Type 1 Diabetes
- Autoimmune thyroid disease, Hypothyroidism
- Atopic dermatitis
- GERD
- Eosinophilic esophagitis
- IBD – more frequently with ulcerative colitis than Crohn’s
- Liver disease
- Idiopathic pulmonary hemosiderosis
- Cardiovascular disease – autoimmune myocarditis, idiopathic dilated cardiomyopathy
- Kidney disease – Glomerular IgA deposition
- Hyposplenism
Common Medications:
- There is no medication for Celiac Disease. The treatment is to stop consuming gluten.
- Corticosteroids may be used if there is severe inflammation that does not response to the gluten-free diet
- Nutritional supplementation may be needed (like iron, Vitamin B12, Vitamin D, etc.)
- Medications for symptoms, like diarrhea, or rash
Common Labs, Imaging, and Tests:
- Serologic testing – tTG-IgA and total IgA, EMA-IgA
- Upper endoscopy with small bowel biopsy
- Vitamins A, D, E, B12, folic acid, ferritin, iron, prothrombin time. May also test for deficiencies in thiamine, B6, magnesium, copper, zinc, selenium
Common Symptoms:
- Some people are asymptomatic
- Abdominal pain
- Diarrhea
- Oily bowel movements that float
- Weight loss
- Bloated
- Feeling full constantly
- Poor appetite
- Gas
- Pruritic rash
- Fatigue
Common Treatments:
- Gluten-free diet
- Management of any nutritional deficiencies
Physical Findings:
- Abdominal tenderness, distention
- Weight loss
- Anemia
- Dermatitis herpetiformis
- Atrophic glossitis (oral lesions)
Potential Complications and Contraindications:
- Constipation
- Increased risk for lymphoma and GI cancer
- Increased risk of microscopic colitis
- Increased risk of pancreatitis
- Nonresponsive celiac disease despite following a gluten-free diet
- Refractory celiac disease
- Ulcerative jejunitis
- Skin conditions – dermatitis herpetiformis is the skin condition most commonly associated with celiac disease (this is itchy and burns, usually located in the lower back, buttocks, face, neck, trunk, knees, elbows)
- Osteopenia
- Medication absorption may be impacted
General Health and Lifestyle Guidance:
- A DEXA scan may be recommended 12 months after starting a gluten-free diet
- Calcium and vitamin D supplements may be recommended by your healthcare provider
- Read food and medication labels carefully
Suggested Questions to Ask Patients:
- Have you been diagnosed with celiac disease or have a family history of it?
- Do you currently follow a gluten-free diet?
- Have you experienced persistent GI symptoms, fatigue, or nutrient deficiencies?
- Have you ever been tested for celiac antibodies or had a biopsy?
- Are you working with a dietitian for meal planning?
Suggested Talking Points:
- Work with your dietician to make sure you’re correctly following a gluten-free diet
- Discuss the pneumonia vaccine with your healthcare provider
- If you experience constipation, talk with your healthcare provider about fiber supplementation
- Some people may need to use separate cooking utensils, toasters, microwaves, etc. from others living in the house to avoid cross-contamination with gluten-containing products
Sources:
- UpToDate
- https://celiac.org/about-celiac-disease/what-is-celiac-disease/
- Cleveland Clinic