e a l t h P r o m o t i o n
The hidden epidemic
Celiac disease affects one
in 100-150 individuals in North America; most remain undiagnosed.
by Dr. Mohsin Rashid
Celiac disease affects one in 100-150
individuals in North America; most remain undiagnosed.
In North America and Europe, one in
every 100 children has celiac disease.
Celiac disease is more common than
Crohn’s disease, ulcerative colitis and cystic fibrosis combined.
The mean delay in diagnosis of celiac
disease in Canadian adults is about 12 years.
What is celiac disease?
Celiac disease (gluten sensitive
enteropathy) is a permanent intolerance to gluten, which causes damage
to the small intestinal mucosa by an autoimmune mechanism in genetically
susceptible individuals. Removal of gluten (a protein present in wheat,
rye and barley) from the diet leads to resolution of symptoms and
restoration of the mucosa to normal.
Clinical features of celiac disease
Celiac disease is a “clinical chameleon.”
The symptoms of celiac disease can be very mild and non-specific, often
leading to delays in diagnosis. A recent survey of the members of
Association revealed that the mean delay in diagnosis in adults was
11.7 years. Diagnoses made prior to celiac disease included anemia (40
per cent), stress (31 per cent) and irritable bowel syndrome (29 per
cent). Prior to diagnosis, 27 per cent of adult respondents consulted
three or more doctors about their symptoms. In children, 24 per cent had
consulted two or more family physicians and 30 per cent had consulted
two or more pediatricians before the diagnosis was established.
Typical symptoms of celiac disease include
abdominal pain, diarrhea and weight loss. However, many individuals
present with atypical symptoms including anemia, extreme weakness,
constipation, mouth ulcers, short stature, osteoporosis, menstrual
irregularities and infertility. Additional symptoms in children include
delayed growth and puberty, vomiting, irritability and dental enamel
Anemia (iron or folate deficiency) is one
of the most common presentations of celiac disease. Celiac disease
should be considered in every patient with iron deficiency anemia
especially when no obvious source of blood loss can be found and/or
there is poor response to oral iron supplements.
Celiac disease is a hereditary disorder.
Both first and second-degree relatives of the person with celiac disease
are at risk of developing the disease. Celiac disease is also associated
with many other autoimmune disorders (especially type I diabetes and
thyroiditis), Down syndrome, Turner syndrome and selective IgA
deficiency. Screening is recommended for these high-risk individuals.
Diagnosing celiac disease
Highly sensitive and specific antibody
tests are available to screen for celiac disease. The currently
recommended tests are either tissue transglutaminase antibody (TTG) or
endomysial antibody (EMA). These serological tests are IgA-based and IgA
deficiency is common in celiac disease. Therefore, serum IgA level must
be measured with these screening tests.
Serologic testing for celiac disease in
children less than five years of age may be less reliable.
The definitive test for celiac disease is
a small intestinal biopsy.
Management of celiac disease
The treatment of celiac disease is a
STRICT gluten-free diet for LIFE. The gluten-free diet should NOT be
started before a biopsy is done, as it may affect the interpretation of
the biopsy and make confirmation of the diagnosis difficult.
Dermatitis herpetiformis (DH) is “celiac
disease of the skin.” If a chronic, severely itchy, blistering rash does
not respond to conventional therapy, DH should be considered. A skin
biopsy will help make the diagnosis of DH and a gluten-free diet will
alleviate the symptoms.
October is National Celiac Awareness
Early diagnosis of celiac disease will
prevent unnecessary suffering, nutritional deficiencies and poor growth.
It may also reduce the risk of developing certain cancers and other
Dr. Mohsin Rashid is a member of the
Faculty of Medicine, Dalhousie University and a member of the
Professional Advisory Board with the Canadian Celiac Association.