Fall 2005

H e a l t h   P r o m o t i o n
Celiac disease: The hidden epidemic

Pharmacia Diagnostics Photo


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 Canadian Celiac 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 defects.

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 month

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 autoimmune disorders.

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.



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