# Celiac Disease: Difficult to Diagnose, Yet No Mystery



## JeanG (Oct 20, 1999)

The url for this article is: http://healthwatch.medscape.com/medscape/p...entType=Library This is a CBSHealthWatch by Medscape article. Celiac Disease: Difficult to Diagnose, Yet No MysteryJoanie Stewart, Medical WriterSep.2000 A potentially serious intestinal disorder known as celiac disease, once considered extremely rare in the United States, may be much more common than experts thought. Researchers at the University of Maryland recently conducted the largest epidemiologic study in this country to date, screening almost 10,000 people. Results of the study show that as many as 2 million Americans, or one in 150 people, may have celiac disease, says the study's author, Dr. Alessio Fasano, codirector of the Center for Celiac Research at the University of Maryland.People with the disease are unable to tolerate foods containing gluten, the protein found in wheat and other grains. But doctors are quick to point out that celiac disease is much more than a simple food allergy. "Unlike allergy symptoms that may come and go, the celiac reaction sets off a cascade of events that can eventually destroy the intestine," says Dr. Fasano. In Europe, diagnosis may take only 4-8 weeks. In the United States, the average diagnosis takes 10 years. Celiac disease is a genetic autoimmune digestive disorder that arises when specific genes encounter the gluten found in wheat, rye, barley, and possibly oats. When people who have the disease eat foods containing even small amounts of gluten, they produce antibodies. The antibodies then attack not only the gluten but also the lining of the small intestine.The antibodies destroy parts of the intestinal wall called villi, and villi are essential to the body's absorption of nutrients. Without them, a person can become malnourished, no matter how much he or she eats. And depending on where in the intestine the villi are destroyed, different nutrients, like iron or calcium, may not be absorbed.Good News, Bad NewsThe good news is that celiac disease can be easily treated in most cases. This is done by simply removing gluten from the diet. "I wish we had the same luxury with other autoimmune diseases," says Dr. Fasano. "We know everything about this disease. We've identified the genes involved, and we know which environmental factors trigger the disease. We can remove grains from the diet, and the person is perfectly normal again." In Italy, all children are screened by age 6 for celiac disease. The bad news, or at least the difficulty, lies in the diagnosis of this so-called "silent" disease. Symptoms can range from typical intestinal problems like vomiting and diarrhea to atypical symptoms that can include Skin rashes. Anemia. Seizures. Weight loss. Chronic fatigue. and even mood swings. And some patients have no symptoms at all.Because Americans are not routinely screened for celiac disease, it is much harder to diagnose patients with unusual symptoms. "A skilled physician who has a patient with anemia due to lack of iron may come up with a diagnosis of celiac disease," says Dr. Fasano. "If you treat the patient with iron by mouth, and the defect is not corrected, then you may realize that the iron is not being absorbed, and that the patient may have celiac."Physicians are much more familiar with the disease in Europe, where diagnosis may take only 4-8 weeks. In Italy, all children are screened by age 6 so that even those without symptoms are identified early. In the United States, the average diagnosis takes 10 years, partly because, until recently, no one suspected it. Beer, many processed foods, and even the glue in postage stamps contain hidden gluten. "While people shop around to their dermatologist, internist, hematologist, or other specialists looking for answers, the disease can get worse," says Dr. Fasano. "The longer the disease goes untreated, the greater the risk for complications of other autoimmune diseases like diabetes, thyroid diseases, and rheumatoid arthritis. And in extreme cases, after years of exposure to grains, a person may develop intestinal cancer."Unfortunately there is no specific patient profile for celiac disease, although it does run in families. It can appear in infancy, when the child is first introduced to foods containing gluten. It may be triggered later in life after childbirth, surgery, viral infection, or severe emotional stress. In other cases, years of eating foods containing gluten may finally take their toll.One thing researchers have learned from European studies is that the earlier a celiac child is introduced to gluten, the more likely he or she will show typical gastrointestinal-related symptoms later.The All-American DietCeliac disease in the United States may well be made worse by our wheat-heavy diet. Foods like pizza, pasta, sandwiches, and burgers contain large amounts of gluten. Other products--including beer, many processed foods, and even the glue in postage stamps--contain hidden gluten. Fortunately, as awareness of people's sensitivity to wheat increases, substitutes like rice flour and soy-based foods are becoming available.But what about our USDA (US Department of Agriculture) Dietary Guidelines, which recommend six to 11 servings of bread, pasta, cereal, and rice per day? Dr. Fasano doesn't think these guidelines should change. In fact, they might be a blessing in disguise for people with celiac disease. "People with this disease who begin eating wheat products early in life present more typical GI [gastrointestinal] symptoms, so it makes it easier to diagnose when it appears. If we followed the European diet, my job would be a lot harder," he says.Dr. Fasano says he believes that celiac disease is the most common genetic-based disease in the United States, although most people who have it don't even know it exists. "I believe people need to take responsibility and demand more from physicians in terms of screening, and from legislators and food manufacturers in terms of labeling. A picture of a grain with an 'X' through it would save people a lot of trouble reading a list of ingredients to see if something is safe," he says.Interestingly, US-owned fast-food chains in Europe serve gluten-free burgers and fries. Maybe, someday, we'll catch up?For more information, including recommendations for a gluten-free diet, visit the NIH Web site (www.niddk.nih.gov/health/digest/pubs/celiac/index.htm#3) on celiac disease.


----------



## wanderingstar (Dec 1, 1999)

Jean, many thanks for this article. It was really helpful. susan


----------

