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Celiac disease (CD) is a common digestive disease in persons of European descent. It is also known as celiac sprue, gluten-sensitive enteropathy, or nontropical sprue. In individuals with CD, gluten (a protein in wheat, barley, and rye) damages the small intestine and results in difficulty absorbing nutrients from food. Up to 1 in 113 people in the United States have CD. The risk is higher (1 in 22) in people with a first-degree relative with CD. The cause of CD is unknown, but environmental, immunologic, and genetic factors all contribute. The September 16, 2009, issue of JAMA includes an article about CD.

CAUSE AND PATHOLOGY
It is believed that there is an immunologic (having to do with the immune system) aspect to CD. Several autoantibodies (antibodies are normal parts of the body that fight against something trying to invade it; autoantibodies are abnormally directed against one's own body) are found in the blood in patients with CD. It is not certain whether these autoantibodies are a cause of CD or a result of damage from it. There is also a genetic component to CD. Almost all patients have a particular gene, but only a small number of people with that gene have CD. When people with CD eat foods or use products containing gluten, the immune system responds by damaging or destroying villi (tiny fingerlike protrusions lining the small intestine). Nutrients from food are absorbed through the small intestine walls into the bloodstream. Villi increase the amount of surface space in the small intestine for absorption of nutrients. Without healthy villi, people become malnourished no matter what they eat.

SYMPTOMS
Symptoms of CD include abdominal bloating or pain; chronic diarrhea; vomiting; constipation; pale, foul-smelling, or fatty stools; and weight loss. Adults may not have as many of these symptoms as children. Rather, adults with CD are more likely to have unexplained anemia (low red blood count), fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in the hands and feet, or an itchy rash known as dermatitis herpetiformis.

DIAGNOSIS AND TREATMENT
Small-intestinal biopsy showing abnormal villi is considered the best way to diagnose CD. Many cases of CD are never diagnosed.

The only treatment for patients with CD is avoiding foods containing or made from wheat, barley, and rye for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. In children, the small intestine usually heals within 3 to 6 months, but it may take years to heal in adults. Oats are safe in small amounts, although oats are often processed in facilities that also process other grains. Rice, potato, soy, and buckwheat are safe to eat. It is important for people with CD to read product labels, as gluten is used as an additive in some medications, lipstick, vitamins, and even Play-Doh.

FOR MORE INFORMATION

• National Institutes of Health
  http://www.digestive.niddk.nih.gov/ddiseases/pubs/celiac/
  http://www.nlm.nih.gov/medlineplus/celiacdisease.html
  
• American Dietetic Association
  http://www.eatright.org
  

Huan J. Chang, MD, MPH, Writer; Alison E. Burke, MA, Illustrator; Richard M. Glass, MD, Editor

JAMA. 2009;302(11):1248.

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RELATED ARTICLE

Small-Intestinal Histopathology and Mortality Risk in Celiac Disease
Jonas F. Ludvigsson, Scott M. Montgomery, Anders Ekbom, Lena Brandt, and Fredrik Granath
JAMA. 2009;302(11):1171-1178.
ABSTRACT | FULL TEXT