Celiac disease is an autoimmune disorder where eating gluten damages the small intestine. Gluten must be eliminated from the diet. Symptoms vary but include abdominal pain, diarrhea, fatigue and weight loss. It is diagnosed through blood tests and confirmed with an intestinal biopsy showing damaged villi. Following a lifelong gluten-free diet allows the intestines to heal and improves overall health. Compliance with the diet reduces risks of complications.

1. CELIAC DISEASE
By: Siobhan McLaughlin
Period: A/B

2. What is Celiac Disease?
• People with celiac disease cannot eat gluten. Gluten is the generic
name for certain types of proteins contained in the common
cereal grains wheat, barley, rye and must be eliminated from the
diet.
• The cause of Celiac Disease, also known as celiac sprue or gluten
sensitive enteropathy (GSE), is still a mystery.
• Celiac Disease is not a food allergy - it is an autoimmune disease.
Food allergies, including wheat allergy, are conditions that people
can sometimes grow out of. This is not the case with Celiac Disease

3. Affected parts of digestive system
• When individuals with CD eat gluten, the villi (tiny hair-like
projections in the small intestine that absorb nutrients from food)
are damaged. This is due to an autoimmune reaction to gluten.
Damaged villi do not effectively absorb basic nutrients.
• If CD is left untreated, damage to the small bowel can be chronic
and life threatening, causing an increased risk of associated
disorders – both nutritional and immune related

4. Signs and Symptoms
• CLASSIC SYMPTOMS MAY INCLUDE • OTHER SYMPTOMS
• Abdominal cramping, intestinal gas • Dental enamel defects
• osteoporosis
• Bloating of the stomach
• Bone or joint pain
• Chronic diarrhea or constipation (or both) • Infertility – male/female
• Steatorrhea – fatty stools • Depression
• Anemia –(folic acid, B12 or iron deficiency ) • Mouth ulcers
• Delayed puberty
• Unexplained Fatigue, weakness and lack of energy
• Migraine headaches
• weight loss with large appetite or weight gain • Tingling or numbness in
hands or feet

5. Diagnosis
• A person seeking diagnosis MUST be following a daily diet that contains gluten for
at least 4 weeks in order for test results to be accurate. Specific antibody blood
tests are the initial step in screening for CD. Patients should always consult with a
physician to ensure proper diagnosis.
• Recommended Blood Tests:
• Anti-tissue transglutaminase antibody (tTG – IgA and IgG)
commonly used whether or not symptoms are present and the most sensitive test
available
• Anti-endomysial antibody (EMA-IgA) – highly specific marker for celiac disease
• Anti-deaminated gliadin peptide (DGP – IgA and IgG)
used when tTG or EMA is negative and in cases where patient is IgA deficient
• Total serum IgA – used to check levels to exclude selective IgA deficiency that
results in a false negative test
• Anti-gliadin antibody (AgA – IgG and IgA) not considered sensitive or specific
enough for adults, but used for children under 2 because tTG and EMA antibodies
may be absent. The anti-DGP test is sensitive in this group.

6. Prognosis
• Dermatitis Herpetiformis (DH) is the skin manifestation of celiac
disease characterized by blistering, intensely itchy skin. The rash
has a symmetrical distribution and is most frequently found on the
face, elbows, knees and buttocks. DH patients can have intestinal
damage without obvious gastrointestinal symptoms.
ASSOCIATED AUTOIMMUNE DISORDERS
• Insulin-dependent Type 1 Diabetes Mellitus, Liver diseases, Thyroid
Disease-Hashimoto’s Thyroiditis, Lupus (SLE), Addison’s Disease,
Chronic Active Hepatitis, Rheumatoid Arthritis, Turner Syndrome,
Sjögren’s Syndrome, Raynaud’s Syndrome, Alopecia Areata and
Scleroderma
• OTHER DISORDERS LINKED WITH CELIAC DISEASE
• Down Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Williams
Syndrome

7. Treatments
• Celiac Disease/Dermatitis Herpetiformis (CD/DH) are chronic disorders.
The only treatment is the lifelong adherence to the gluten-free diet. When
gluten is removed from the diet, the small intestine will start to heal and
overall health improves. Medication is not normally required. Consult your
physician regarding specific nutritional supplementation to correct any
deficiencies. The diagnosed celiac should have medical follow-up to
monitor the clinical response to the gluten-free diet.
Adapting to the gluten-free diet requires some lifestyle changes. It is
essential to read labels which are often imprecise, and to learn how to
identify ingredients that may contain hidden gluten. Even small amounts
of ingested gluten can affect those with CD and cause health problems.
Dietary compliance increases the quality of life and decreases the
likelihood of osteoporosis, intestinal lymphoma and other associated
illnesses.

8. Gluten free diet
• ALLOWED Grains/Flours
Rice, corn (maize), soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot,
amaranth, teff, Montina®, flax, and nut flours
• Oats
Research indicates that pure, uncontaminated oats consumed in moderation (up to 1/2 cup dry oats
daily) are tolerated by most celiacs. Gluten-free oats are currently available in the United States. Consult
your physician or dietician before including oats in your diet and for regular monitoring.
• Distilled alcoholic beverages and vinegars are gluten-free. Distilled products do not contain any harmful
gluten peptides. Research indicates that the gluten peptide is too large to carry over in the distillation
process. This process leaves the resultant liquid gluten-free.
• Wines and hard liquor/distilled beverages are gluten-free. Beers, ales, lagers and malt vinegars that are
made from gluten-containing grains are not distilled and therefore, are not gluten-free. Gluten-free
beers are available in the United States.
• NOT ALLOWED IN ANY FORM
Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt), rye, barley and triticale
• Frequently overlooked foods that may contain gluten and need to be verified:
• Brown rice syrup
• Breading & coating mixes
• Croutons
• Energy Bars
• Flour or cereal products
• Imitation bacon

9. Prognosis
• Gastrointestinal complaints and symptoms are less complained
once the gluten free diet is followed
• Patients with celiac disease have typical mortality rates compared
to the general population
• Cancer of the gastrointestinal tract (both carcinoma and
lymphoma)
• Small number of patients that develop a refractory type of celiac
disease