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FALL 2007 |
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Online Only
H
E A L T H P R O M O T I O N
Lessons from
the Canadian celiac health survey
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Stock Photo |
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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.
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By Dr. Mohsin Rashid |
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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 diet leads to
resolution of symptoms and restoration of the mucosa to normal.
Celiac disease is a common
gastrointestinal disorder. Recent prevalence studies indicate that 1 in
ever 100-150 individuals in North America may be suffering from this
disorder. An estimated 300,000 Canadians may have celiac disease, the
vast majority still undiagnosed. Untreated, the individuals are at risk
of nutritional deficiencies, intestinal lymphoma and possibly
development of other autoimmune disorders.
Celiac disease is a “clinical chameleon”.
Typical symptoms of celiac disease include abdominal pain, diarrhea and
weight loss. However, many individuals present with atypical symptoms
including anemia, fatigue, constipation, mouth ulcers, short stature,
osteoporosis, menstrual irregularities and infertility. Additional
symptoms in children include delayed growth and puberty, vomiting,
irritability and dental enamel defects. Celiac disease is a hereditary
disorder. Both first and second-degree relatives are at risk of
developing celiac disease. Other high-risk groups include individuals
with other autoimmune disorders (especially type I diabetes and
thyroiditis) and Down Syndrome.
Serological screening with IgA tissue-transglutaminase
(tTG) antibody is recommended in individuals suspected of having celiac
disease. However, the definitive test for celiac disease is a small
intestinal biopsy. 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 will affect the interpretation of the
biopsy and make confirmation of the diagnosis difficult.
Awareness of celiac disease amongst the
health professionals is poor and delays in diagnosis are common. This
finding is further confirmed by the results of the Canadian Celiac
Health Survey published earlier this year (See Reference list). In 2002,
the Canadian Celiac Association (CCA) conducted this large national
survey of its membership to characterize the diagnostic process,
frequency of associated disorders, family history, and impact of a
gluten-free diet in individuals with celiac disease.
The respondents included 2,681 adults with
biopsy-proven celiac disease. Most common presenting symptoms included
abdominal pain (83%), diarrhea (76%), and weight loss (69%). The most
striking finding of the survey was the mean delay in diagnosis of 11.7
years. Diagnoses made prior to celiac disease included anemia (40%),
stress (31%), and irritable bowel syndrome (29%). Associated conditions
like osteoporosis were common. Prior to diagnosis, 27% of respondents
had consulted three or more doctors about their symptoms.
The data in 168 children (<16 years of
age) showed similar results. The presenting symptoms included abdominal
pain (90%), weight loss (71%), diarrhea (65%), weakness (64%),
nausea/vomiting (53%), anemia (40%) and constipation (30%). Almost
one-third of families consulted >2 pediatricians before confirmation of
the diagnosis. Before the recognition of celiac disease, other diagnoses
received by these children included anemia (15%), irritable bowel
syndrome (11%), gastroesophageal reflux (8%), stress (8%), and peptic
ulcer disease (4%).
October is National Celiac Awareness
month
Improved awareness of celiac disease and
greater use of serological screening tests will result in earlier
diagnosis and reduced risk of associated conditions.
References
(1). The Canadian Celiac Health Survey Cranney A, Zarkadas M, Graham ID,
Butzner JD, Rashid M, Warren R et al. Digestive Diseases & Sciences
2007;52(4):1087-1095
(2). The impact of a gluten-free diet on adults with coeliac disease:
Results of a national survey Zarkadas M, Cranney A, Case S, Molloy M,
Switzer C, Graham ID et al. Journal of Human Nutrition & Dietetics
2006;19:41-49
(3). Celiac disease: Evaluation of the diagnosis and dietary compliance
in Canadian children Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer
C, Case S et al. Pediatrics 2005; 116: e754 - e759
Dr. Mohsin Rashid, FRCP(C) is a member of
the Faculty of Medicine at Dalhousie University and is a member of the
Professional Advisory Board with the Canadian Celiac Association. For
more information about the Celiac Association, visit their website at
www.celiac.ca
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