Celiac Disease: Seeking Proper Treatment

By: Sang Hyo Kim, Staff Editor

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The Mayo Clinic reported in the American Journal of Gastroenterology that 1.8 million people in the United States suffer from celiac disease.¹ More notably, of this population, over 75% of people are unaware that they even have this condition. While other studies have been conducted to determine the prevalence of diagnosed and undiagnosed celiac disease, the one performed by Mayo Clinic reveals the most definite results thus far.^1,2 It is crucial for those who suffer the symptoms of celiac disease to be tested; though some symptoms may coincide with other bowel syndromes, it is in the best interest of the patient to seek immediate help so he/she can receive necessary medical guidance.

Celiac disease is an autoimmune disease wherein the immune systems attacks gluten, a type of protein found in foods such as bread, crackers, and pasta. The immune response to gluten causes destruction of the villi in the small intestine and therefore makes it more difficult for the body to absorb nutrients. Symptoms can be mild or severe and include gas and bloating, changes in bowel movements, weight loss, fatigue, and weakness.³ Some patients may vomit after they ingest gluten, however this is more common in adults.

While the cause of celiac disease remains unknown, genetics may be involved. Celiac disease can develop at any point in life, and is most common in Caucasians and persons of European ancestry. Current statistics further show that 60% to 70% of those diagnosed with celiac disease are women.^4,6

If a patient demonstrates symptoms of celiac disease, the physician will order blood tests that detect special antibodies called antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If the test is positive, a gastroenterologist will perform an upper endoscopy to sample a piece of tissue from the first part of the small intestine, specifically the duodenum, to determine if any flattening of the villi is present.⁷ Once a person has been diagnosed, the next step is for the healthcare provider to explain to the patient the course of the disease and the importance of diet modification. Currently, there is no cure for celiac disease. However, symptoms will be attenuated and the intestinal villi can heal if a patient follows a lifelong gluten-free diet. Reading food labels is very important in determining whether a product may contain sources of grains and ingredients from wheat, barley, rye, and oats.

It is estimated that 1.6 million people in the U.S are on a gluten-free diet even though they have never been formally diagnosed with celiac disease.⁴ However, Dee Sandquist, a registered dietitian and spokesperson for the American Diabetic Association, says  “there’s nothing inherently healthier about a gluten-free diet.” This is because “gluten-free” products may contain extra sugar and fat to imitate the satisfaction that gluten contributes, and lack vitamins B and D normally found in regular bread products. Therefore, rather than buying products labeled “gluten-free,” Mr. Sandquist recommends that people choose more fruits, vegetables, and lean meats.⁵

Since gut nutrient absorption may be compromised in a patient with celiac disease, healthcare providers may also prescribe vitamin and mineral supplements. Pharmacists can contribute to the celiac patient’s health by “counseling the patient about gluten-free diet, drugs, vitamins, and nutritional supplements and addressing other health related matters,” according to Dr. Robert A. Mangione, EdD, RPH and Dr. Priti N. Patel, PharmD, BCPS.⁸ Furthermore, since medications may contain small amounts of gluten, pharmacists should be made aware of these patients’ medical condition to avoid exacerbation of the disease, if possible. Thus, while adhering to a gluten-free diet is difficult for many, celiac disease patients must carefully follow well-balanced and gluten-free diet to stay healthy and symptom-free.

 

SOURCES:

1. Many People With Celiac Disease Are Unaware Of It. MNT Web site. <http://www.medicalnewstoday.com/articles/248523.php> Published August 2nd, 2012. Accessed December 1st, 2013
2. About Mayo Clinic. Mayo Clinic Web site. <http://www.mayoclinic.org/about/> Accessed December 1st, 2013.
3. Signs & Symptoms. Celiac Support Association. <http://www.csaceliacs.info/symptoms_of_celiac_disease.jsp> Accessed January 22nd, 2014.
4. Mayo Clinic: 80% of People on Gluten-Free Diet Do Not Have Celiac Disease Diagnosis. nfca. http://www.celiaccentral.org/research-news/mayo-clinic-80-percent-gluten-free-diet-no-celiac-disease-diagnosis-8306/.> Accessed May 15th, 2014
5. Storrs, C. Will a gluten-free diet improve your health? CNN Health.  http://www.cnn.com/2011/HEALTH/04/12/gluten.free.diet.improve/ Published April 12th, 2011. Accessed May 15th, 2014
6. Celiac Disease Prevalence in Women. nfca, <http://www.celiaccentral.org/education/Women-s-Health/Prevalence/453/.> Accessed May 15th, 2014.
7. Celiac Disease-Sprue. The New York Times Web site. <http://www.nytimes.com/health/guides/disease/celiac-disease-sprue/overview.html>
8. Accessed December 2nd, 2013.
9. Mangione, Robert A, Patel, Priti N. Pharmaceutical Care of Celiac Disease. U.S Pharmacist. <http://www.uspharmacist.com/content/d/feature/c/31428/>. Published December 20th, 2011. Accessed May 15th, 2014.

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