Celiac Disease In Adults

Who is at Risk?

Individuals with certain genetic markers, specifically HLA-DQ2 or HLA-DQ8 genes, are predisposed to celiac disease. Having a first-degree relative (parent, sibling, or child) with celiac disease increases one's risk by about 10%. Additionally, people with other autoimmune disorders, like type 1 diabetes or autoimmune thyroid disease, and those with chromosomal conditions such as Down syndrome, are at higher risk.

Prevalence and Global Impact

Celiac disease affects approximately 1% of the global population, though many cases remain undiagnosed. Prevalence varies by region: about 0.5% in North America and Africa, 0.6% in Asia, and up to 0.8% in Europe and Oceania. In India, estimates suggest 6 to 8 million people may be affected. The disease imposes significant health burdens, including increased risks of malnutrition, osteoporosis, infertility, and certain cancers, underscoring the need for greater awareness and early diagnosis.

Causes and Risk Factors of Celiac Disease

Causes:

• Genetic Predisposition: Approximately 95% of individuals with celiac disease possess HLA-DQ2 or HLA-DQ8 gene variants. However, only about 3% of those with these genes develop the condition. 

• Gluten Consumption: Ingestion of gluten—a protein found in wheat, barley, and rye—triggers an abnormal immune response in susceptible individuals, leading to damage to the small intestine's lining.

• Immune System Reaction: The body's immune response to gluten damages the villi in the small intestine, impairing nutrient absorption. 

• Environmental Triggers: Factors such as gastrointestinal infections, alterations in gut microbiota, and significant physical or emotional stressors like surgery or childbirth may contribute to the onset of the disease.

Risk Factors:

• Family History: Having a first-degree relative (parent, sibling, or child) with celiac disease increases one's risk by about 10%.

• Autoimmune Disorders: Individuals with other autoimmune conditions, such as type 1 diabetes or autoimmune thyroid disease, are at higher risk.

• Genetic Syndromes: Conditions like Down syndrome, Turner syndrome, and Williams syndrome are associated with an increased risk.

• Microscopic Colitis: This inflammatory condition of the colon is linked to a higher incidence of celiac disease.

• Addison's Disease: An autoimmune disorder affecting the adrenal glands, which is associated with a higher risk of celiac disease.

Celiac Disease Symptoms

Celiac disease manifests with a wide array of symptoms, which can vary significantly between individuals and age groups. Below is a categorised list of common symptoms:

Digestive Symptoms (More Common in Children)

• Abdominal bloating and pain

• Chronic diarrhoea or constipation

• Pale, foul-smelling, or fatty stools (steatorrhea)

• Nausea and vomiting

• Gas and flatulence

• Lactose intolerance due to intestinal damage

• Weight loss or failure to thrive in children

• Delayed puberty and short stature

Non-Digestive Symptoms (More Common in Adults)

• Fatigue and weakness

• Iron-deficiency anemia

• Bone or joint pain

• Osteoporosis or osteomalacia (softening of bones)

• Itchy, blistering skin rash (dermatitis herpetiformis)

• Mouth ulcers and canker sores

• Headaches or migraines

• Peripheral neuropathy (tingling or numbness in hands and feet)

• Cognitive impairment or "brain fog"

• Depression, anxiety, and mood changes

• Missed menstrual periods, infertility, or recurrent miscarriages

• Delayed growth and development in children

It's important to note that some individuals with celiac disease may be asymptomatic yet still experience intestinal damage. If you suspect celiac disease, consult a healthcare professional before initiating a gluten-free diet, as this can affect diagnostic test results.

Nutritional Deficiencies and Malnutrition

• Iron-Deficiency Anaemia: Damage to the small intestine impairs iron absorption, leading to anaemia characterised by fatigue, weakness, and shortness of breath. 

• Vitamin and Mineral Deficiencies: Malabsorption can result in deficiencies in calcium, vitamin D, vitamin B12, folate, and other essential nutrients, affecting various bodily functions.

• Weight Loss and Growth Issues: Inadequate nutrient absorption can lead to unintended weight loss in adults and growth delays in children.

Bone Health Complications

• Osteopenia and Osteoporosis: Calcium and vitamin D deficiencies weaken bones, increasing the risk of fractures.

• Osteomalacia and Rickets: In children, vitamin D deficiency can cause bone softening, leading to deformities.

Reproductive and Pregnancy Issues

• Infertility: Nutrient deficiencies and hormonal imbalances can affect fertility in both men and women.

• Pregnancy Complications: Increased risks of miscarriage, preterm birth, and low birth weight are associated with untreated celiac disease.

Neurological and Mental Health Disorders

• Peripheral Neuropathy: Nerve damage leading to tingling, numbness, or pain in the hands and feet.

• Seizures and Migraines: Neurological symptoms may arise due to nutrient deficiencies and immune responses.

• Depression and Anxiety: Psychological issues can result from chronic illness and nutrient imbalances.

Increased Cancer Risk

• Intestinal Lymphoma: Chronic inflammation elevates the risk of certain gastrointestinal cancers.

• Small Bowel Cancer: Prolonged, untreated celiac disease can lead to malignancies in the small intestine.

Other Health Complications

• Liver Disorders: Elevated liver enzymes and liver diseases like autoimmune hepatitis can occur.

• Lactose Intolerance: Damage to the intestinal lining may lead to temporary lactose intolerance.

• Additional Autoimmune Diseases: Increased susceptibility to conditions like type 1 diabetes and autoimmune thyroid disease.

Adhering to a strict gluten-free diet is essential to prevent these complications and promote intestinal healing. If you suspect you have celiac disease, consult a healthcare professional for appropriate testing and guidance.

How is Celiac Disease Diagnosed?

Celiac disease is diagnosed through a combination of medical history, physical examination, and specific tests. Initially, serologic blood tests are conducted to detect elevated levels of antibodies such as anti-tissue transglutaminase (tTG-IgA) and anti-endomysial antibodies (EMA), which indicate an immune response to gluten. If these tests are positive, an upper endoscopy with a small intestine biopsy is performed to assess damage to the intestinal villi. Genetic testing for HLA-DQ2 and HLA-DQ8 genes may also be utilised to support the diagnosis. It's crucial to continue consuming gluten before testing, as eliminating it can lead to false-negative results.

Celiac Disease Treatment in Delhi 

Primary Treatment

• Strict Gluten-Free Diet: The cornerstone of celiac disease management is a lifelong, strict gluten-free diet, eliminating all sources of wheat, barley, rye, and their derivatives. This approach allows the small intestine to heal and prevents further damage.

• Dietitian Consultation: Working with a registered dietitian experienced in celiac disease can help in planning balanced meals, identifying hidden gluten sources, and ensuring nutritional adequacy.

Nutritional Support

• Vitamin and Mineral Supplements: Due to malabsorption, supplementation of iron, calcium, vitamin D, vitamin B12, folate, and other nutrients may be necessary to correct deficiencies.

Medications

• For Dermatitis Herpetiformis, medicated ointments may be prescribed to control the itchy skin rash associated with celiac disease.

• For Refractory Celiac Disease: In cases where symptoms persist despite a strict gluten-free diet, corticosteroids or immunosuppressive medications may be considered.

Follow-Up Care

• Regular Monitoring: Periodic follow-up with healthcare providers is essential to monitor symptom improvement, nutritional status, and adherence to the gluten-free diet. Blood tests and, in some cases, repeat biopsies may be conducted.

Emerging Therapies (Under Investigation)

• Enzyme Therapies: Research is ongoing into enzymes that can break down gluten in the digestive tract, potentially reducing its harmful effects.

• Immune Modulation: Investigational treatments aim to modulate the immune response to gluten, including the development of inverse vaccines and monoclonal antibodies targeting specific immune pathways. 

• Cell-Based Therapies: Early-stage research is exploring the use of engineered regulatory T cells to suppress the autoimmune response in celiac disease.

Conclusion

Manipal Hospital Dwarka has the best gastroenterology doctor in Delhi, experienced in treating any kind of gastrointestinal problems. For celiac disease treatment, consult the best cancer hospital in Delhi.