Celiac Disease: Myths and Facts

Celiac disease is a genetically inherited autoimmune disorder triggered by dietary gluten that damages the intestinal villi in the proximal small intestine. Once tall and slender, the damaged villi become blunted or completely flattened. As a result, the available absorptive area is reduced considerably, which causes malabsorption. This condition affects both children and adults. In young children, celiac disease most commonly is detected some time (typically months) after cereals have been introduced to the diet. In older children and adults, frequently it is diagnosed following various challenges to the immune system. These types of challenges include infections, pregnancy and childbirth, and surgery. Once diagnosed, the disease is treated with a lifelong adherence to a gluten-free diet, which requires the patient to avoid dietary gluten found in wheat, rye, and barley and products derived from these sources. Consultation with a knowledgeable dietitian can help a patient and family adopt the diet and avoid learning that a product contains gluten after the fact. DISPELLING THE MYTHS OF CELIAC DISEASE Unfortunately, many myths still abound about celiac disease, and these misunderstandings on the part of physicians result in critical delays in diagnosis. In the United States, an adult typically receives a diagnosis of celiac disease more than 10 years after symptoms are first noted. This delay in diagnosis is considerably shorter in children, who tend to experience less subtle symptoms including short stature, diarrhea, stomach pain, and behavior changes. Commonly, adult patients may suffer for years with anemia, fatigue, and mild or vague abdominal symptoms such as bloating, pain, loose stools, or constipation. Many receive a diagnosis of irritable bowel syndrome and may be referred to psychiatric counseling after therapies are unsuccessful. Even many of those who finally undergo an upper-digestive endoscopy may not be fortunate enough to receive an accurate diagnosis; when results of an endoscopic examination of the duodenum are normal, physicians often do not obtain duodenal biopsies. Unfortunately, this is the rule, not the exception, for patients with celiac disease.