Celiac disease is an autoimmune disorder of the gastrointestinal tract that is driven by exposure to dietary gluten. Gluten is a storage protein in barley, wheat and rye, and thus difficult to avoid. It was once thought to be rare, but studies estimate that up to one in 300 people may have a form of this disorder. And it is not new—rather, it is being diagnosed more frequently and with more certainty today. It is common in North America and Europe, and especially in those of European and Middle Eastern descent.
Celiac disease is inheritable and genetic. Two specific histocompatibility antigens, HLA-DQW2 and HLA-DR3 are specifically linked. It is characterized by chronic inflammation of the mucosa of the small intestine, and eventually causes small areas in the intestine to atrophy. This in turn leads to malabsorption and prominent symptoms. Celiac disease can run the gamut from being a minor inconvenience to severely affecting people and may develop at any age. As with many autoimmune diseases, it is two to three times more common in women, and people who have other autoimmune diseases such as thyroid problems or diabetes are more prone to developing celiac disease.
Early on, celiac disease doesn’t have a lot of specific symptoms. Diarrhea and flatulence are probably the most common two, but they are intermittent and don’t show a lot of physical findings on a doctor’s exam. As time passes, symptoms become more prominent, with abdominal pain, bloating, malabsorption and significant discomfort. The diagnosis is best made with a high index of suspicion. While iron deficiency, folate deficiency, weight loss and some electrolyte abnormalities may occur during the course, generally both doctor and affected individual are led to diagnostic suspicion by relating it to foods they have eaten. Lactose intolerance is usually the number one suspected problem, but when withdrawal of milk products doesn’t seem to solve the problem, celiac disease needs to be suspected.
The diagnosis of celiac disease is made through the use of serologic tests, a biopsy of the small bowel on endoscopic exam, and the reaction to the withdrawal of gluten containing substances. The serologic testing doesn’t always make the diagnosis on its own, and the biopsies are needed to confirm. Early in the disease neither test may be definitive and empirical treatment with a gluten-free diet has to be instituted. While symptom relief may occur rapidly, the testing and microscopic changes may take 6 to 12 months to reverse post institution of the diet.
So what is a gluten-free diet? Grains that must be avoided are wheat, barley, malt and rye. This is no easy task, given that these make up the majority of the American diet. The internet is an excellent source of listings of foods that are gluten-free, and much newer packaging, particularly in health food stores, makes this more obvious. However, this can get significantly more expensive, and dining out is always an unknown. Meats, vegetables, fruits and dairy products are gluten-free, making this one way to differentiate this from lactose intolerance. Generally it is advisable to get testing anyway, as conditions like irritable bowel syndrome, reflux and flatulence improve with a gluten-free diet, and a definitive diagnosis by biopsy is still the way to go.
When the diagnosis of malabsorption is uncertain, insurers will wait for a cause to be determined. Most people with mild to moderate celiac disease are insured standard, with only the severe, more stubborn cases causing problems. More than 90 percent of people with celiac disorder improve significantly with a gluten-free diet, but compliance is difficult and the control needed to monitor food intake religiously is not easy, especially in a convenience-oriented world.
