Celiac disease: All you need to know

People affected by celiac disease suffer from hypersensitivity of the intestine to gluten, a component of many grains. Eating gluten-containing foods causes inflammation of the mucous membrane in the small intestine. Very often, the disease takes the form of indigestion such as diarrhea, but other symptoms are also possible. The disease can occur for the first time in childhood or in adulthood. Diet is very important with celiac disease: A gluten-free diet relieves the symptoms and prevents consequential damage.

**The most important information at a glance**

• Celiac disease is a form of gluten intolerance.
• Gluten is a specific type of protein (“glue protein”), mainly contained in grains.
• When eating gluten-containing food, chronic mucous membrane inflammation of the small intestine develops.
• Celiac disease occurs in infants, in toddlers, and in adults.
• The disease is also referred to as “gluten-sensitive enteropathy”.
• Several factors seem to contribute, including one’s genetic predisposition and modern eating habits.
• Common celiac symptoms include abdominal pain, diarrhea, or flatulence.
• No cure is possible, according to current research.
• The therapy is to follow a strictly gluten-free diet.

What symptoms can occur with celiac disease?

Common symptoms of celiac disease include the following:

• Diarrhea and constipation
• Greasy, yellowish-gray fatty stools (steatorrhea)
• Flatulence
• Loud, gurgling intestinal sounds (also known as broborygmus)
• Very swollen abdomen
• Abdominal pain (caused by the pressure from gas)

The symptoms of celiac disease can be very stressful for those affected. Everyday life is often restricted due to the severe digestive problems. But the symptoms are not just painful: Many celiac sufferers are ashamed of their bowel sounds, which cannot always be suppressed and may be very loud.

There are also other symptoms in addition to the problems with digestion. Normally, important nutrients are absorbed via the wall of the small intestine. Celiac disease causes inflammation, and food intake is impaired so deficiency symptoms can arise.

Physical weakness and fatigue can occur in both adults and children. In children with celiac disease, the disease often reveals itself through weight loss. Growth disorders can also be the result of celiac disease.

Other consequences include:

• Listlessness and depressive moods
• Anemia due to the lack of iron and folic acid intake, as well as the tendency to bleed
• Painful tears in the corners of the mouth (rhagades)
• Bone softening (osteomalacia) or bone loss (osteoporosis)
• Damage to teeth enamel
• Weakness and loss of strength in arms and legs
• Insecurity with walking and standing
• Abnormal sensations such as tingling, numbness
• Skin symptoms in the context of accompanying skin diseases
• Susceptibility to infection
• In women: Cycle irregularities and possibly infertility

When does celiac disease occur?

It is generally possible for the disease to occur at any age. Babies cannot report their symptoms, so parents should go to the pediatrician if there are typical signs. The first signs may be persistent abdominal pain, poor health and greasy stools. Many children show celiac disease symptoms in the first few months after birth. Most complaints occur as soon as infants receive more cereal-rich food in the form of porridge. But there are also people who get ill only in adulthood.

What is the cause of celiac disease?

An interaction of various factors is discussed as the cause for the development of celiac disease. The disease seems inheritable and occurs frequently in some families. When an identical twin develops celiac disease, the risk is around 80 percent that the disease will soon develop in their sibling.

In addition, grain is a relatively new component of the human diet. Humanity spent most of its time as hunter-gatherers. Grain was included in our daily diet only after the start of agriculture. This could explain the body's reaction to the grain component gluten.

Celiac disease is an autoimmune disease. A person’s own immune system is hypersensitive here to an actually harmless substance; in the case of celiac disease, it is a reaction to gluten. There is an inflammatory reaction of the mucous membrane in the small intestine when sufferers consume gluten-containing foods. If they do not change their diet, it can lead to permanent damage to the intestine. Other health consequences are possible.

Celiac disease often occurs with other diseases, such as diabetes mellitus type 1. This form of diabetes, like celiac disease, is associated with an overreaction of the immune system.

How is celiac disease diagnosed?

Indigestion is usually the first indication of the disease. However, more than half of cases are untypical and can express many different symptoms. If celiac disease is suspected, the doctor will conduct blood tests to determine the antibodies that are produced by the disease. To make sure that it is celiac disease, a colonoscopy with removal of tissue samples is also necessary.

Adherence to a gluten-free diet “with a suspicion” prior to further diagnosis is unfavorable as this may lead to a false result. There are ongoing efforts to develop testing that can replace the colonoscopy and be, as a result, more pleasant.

Is it important to discover celiac disease early?

An early diagnosis of celiac disease is very important because a gluten-free diet usually leads to symptoms improving quickly. Those affected can also avoid subsequent harm.

Permanent inflammation in the intestine can damage its function in the long term. Possible deficiencies can also lead to nerve damage, affect hormone balance and impair physical performance. In the long term, persistent inflammation can also increase the risk of certain types of cancers of the digestive system.

Untreated celiac disease can lead to deficiency in iron, folic acid, and vitamins. Insufficient calories are also often consumed, which can lead to weight loss. In children, such deficiencies are particularly serious, as they are still growing and are particularly dependent on an adequate nutrient supply. The child cannot thrive due to undiscovered celiac disease: their growth is deficient, and nerve damage can even result. Early diagnosis of celiac disease in children and adults is extremely important.

Celiac disease is a serious condition that is not curable, which is why a gluten-free diet is all the more important: An appropriate diet reduces symptoms and improves one’s quality of life.

What is the treatment for celiac disease?

The most important way to relieve the symptoms of celiac disease is a gluten-free diet. This includes not using grain products such as bread or cereal, as they contain gluten. Natural, gluten-containing grain products include wheat, rye, barley, spelt, and unripe spelt grains. Gluten-free foods include rice, corn, potatoes, soybeans, buckwheat, millet and, in some cases, oats.

Gluten is also found in many finished products. Even gluten-free products may show traces of gluten when exposed to gluten-containing products during processing. This may be the case, for example, with rice or oats. Only gluten-free products, which are also explicitly labeled as such, are actually gluten-free and can be consumed by sufferers without risk. Gluten-free food can be recognized by the symbol of a crossed out grain of wheat.

Celiac sufferers have to ensure the strict separation of gluten-containing and gluten-free foods at home. Since gluten-containing foods are a big part of the daily diet, most people's shopping habits have to change. This is initially tedious and can be expensive. In the long term, however, this increases the quality of life of those affected.

What can help in addition to diet?

Celiac disease is a diagnosis that changes everyday life: It requires a lifelong change in diet, and doctor visits are also part of it. People with celiac disease usually have to precisely plan their meals. Some sufferers also have to contend with other diseases in addition to celiac disease.

But people who are affected by this disease do not have to feel alone with their problems. Discussions with other patients can provide valuable support. How do others deal with the diagnosis and symptoms? What attitude to the disease do they have, and how do they successfully master everyday life despite celiac disease? These questions can be discussed in self-help groups or in internet forums, where sufferers can get valuable tips on dealing with their illness.