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What is Celiac Disease?

What are the Symptoms of Celiac Disease?

Patients with CD can present with a variety of symptoms. The most common (typical) include chronic diarrhea, abdominal pain, malabsorption and weight loss. However, many patients now present with non-classical (atypical) symptoms including anemia, osteoporosis, extreme fatigue, oral ulcers, liver enzyme abnormalities, constipation, infertility, dental enamel defects, neurological problems, etc. Since many patients with CD do not present with classical symptoms, delays in diagnosis can occur.

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Gluten Free

What is the treatment for Celiac Disease?

Unfortunately, there is no cure for celiac disease. The only available treatment for celiac disease is to remove gluten from the diet - the so-called Gluten-Free Diet. Patients with CD must avoid any foods containing wheat, rye and barley. Some common gluten-containing food and beverage examples are bread, pasta and beer. 

Even small amounts of gluten intake, such as bread crumbs from a toaster, can trigger the immune reaction and cause inflammation in the small intestine. Therefore patients with CD must be trained appropriately on a gluten-free diet to understand what foods should be avoided and the common sources of cross-contamination.

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How is Celiac Disease Diagnosed?

A proper diagnosis of celiac disease is essential for adequate medical care. The first step to diagnose celiac disease is often through a blood test to evaluate the presence of antibodies against a molecule in our body called tissue transglutaminase 2 (tTG2). Sometimes other antibodies are measured such as anti-endomysial (EmA) or anti-deaminated gliadin peptides (DGP). If the blood test is abnormal, the diagnosis is confirmed by small biopsies taken from the small intestine during an endoscopy.  A positive biopsy is one that shows the characteristic flattening of the intestinal lining (or mucosa), which we call “atrophy”. Until the diagnosis is confirmed it is important to keep consuming foods that contain gluten. If however, you started a gluten-free diet before, your doctor may ask you to start eating gluten (called the gluten challenge) before the testing. In addition to the blood test and endoscopy, a genetic test may be required to assess the presence of celiac risk genes (HLA-DQ2 and HLA-DQ8). Although carrying these genes is not a diagnosis for celiac disease, a negative test excludes the possibility of having the disease.

Celiac Disease: Services

Celiac disease is an autoimmune condition caused by an immune reaction to gluten, and it affects around 1 to 2% of the population. Gluten is the most common protein found in wheat, barley and rye.   
In patients with Celiac Disease, eating gluten causes inflammation in the small intestine, leading to damage of its villi - the small finger-like projections found along the small intestine wall – and consequent impairing the absorption of some nutrients (malabsorption).

Cutting Bread

The Gluten Challenge

If you are currently on a gluten-free diet, your physician may ask you to do a gluten challenge before any further investigation. The gluten challenge involves eating 10 g of gluten (the equivalent of two slices of (gluten-containing) bread daily, for a period of 4-6 weeks. This will allow your body to develop the immune response against gluten that will be detected in the blood (antibodies) and/or the small intestinal biopsies. Without the challenge, the diagnosis of celiac disease in people who are already following a gluten-free diet is difficult.

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