Celiac Disease: An Often Missed Diagnosis

Celiac disease: an often missed diagnosis

Commonly referred to as wheat allergy, celiac disease is not an allergic disorder; rather it is actually intolerance to gluten, a protein in wheat. It is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy. Celiac disease occurs in people who have a genetic susceptibility. It was considered a north European disease initially but now it has a high prevalence in all the continents. In north- India it affects 1 in 200-300 individuals, similar to its prevalence in Europe.

Celiac disease is primarily a digestive condition triggered by consumption of the protein gluten resulting in an immune reaction in the small intestine, which leads to inability to absorb certain nutrients from food. Eventually, decreased absorption of nutrients (malabsorption) causes vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment. The decreased nutrient absorption that occurs in celiac disease is especially serious in children, who need proper nutrition to develop and grow.

Unfortunately awareness about this disease is very poor among the population and even among doctors. Celiac disease is seen primarily by pediatricians and gastroenterologists but increasingly endocrinologists, hematologists and internists are getting patients of this malady.

Signs and symptoms

There are no typical signs and symptoms of celiac disease. In children it manifests early with diarrhea which starts when the child is weaned off milk and started on solid diet. Another common manifestation in children is stunting of growth or failure to gain height and weight .School performance may get affected in some children. In India celiac disease has been recognized in children for the last over 40 years but it has attracted the attention of those caring for adults only in the last decade.

Most adult people with the disease have general complaints, such as intermittent diarrhea, abdominal pain and bloating. Sometimes people with celiac disease may have no gastrointestinal symptoms at all. In fact half of the adult celiac disease patients coming to PGI do not have any abdominal symptoms. The most common non –gastrointestinal symptom is iron deficiency anemia followed by weight loss. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, parasite infections, skin disorders or bone disease. Celiac disease may also present itself in less obvious ways, including irritability or depression, joint pains, muscle cramps, mouth sores, dental and bone disorders (such as osteoporosis), and tingling in the legs and feet (neuropathy).

When to seek medical advice

If you notice or experience any of the signs or symptoms common to celiac disease, see your doctor. If someone in your family is known to have celiac disease, you may need to be tested. Starting the process will help you avoid complications associated with the disease, such as osteoporosis, anemia and certain types of cancer. Seek medical attention for a child who is pale, irritable, fails to grow and who has foul smelling stools. Many other conditions can cause these same signs and symptoms, so it's important to talk to your doctor before trying a gluten-free diet.

Left untreated, celiac disease can lead to several complications:

 Malnutrition. Untreated celiac disease can lead to malabsorption, which in turn can lead to malnutrition. This occurs in spite of what appears to be an adequate diet. Because vital nutrients are lost in the stool