Common Symptoms Make Celiac Diagnosis Difficult

What do peanut butter, gravy, salad dressing, yogurt, reduced-fat products, fruit pie fillings and french fries all have in common?

Ask a person with celiac disease, and he or she will tell you that these items contain gluten and are on the long list of items they cannot consume. They know these items to cause great discomfort and are avoided at all costs.

CELIAC DISEASE IN PERSPECTIVE:

"This is not a new disease, but it goes unrecognized quite often," said Charles Cohan, D.O., of Pocono Gastroenterology Associates. "The condition was first clinically described in 1888. Celiac disease is an immune-mediated inflammatory disorder of the small intestine caused by a sensitivity to gluten."

So why do so many go undiagnosed?

"The classic form of the disease is diarrhea. While there are many possible symptoms, some people are asymptomatic, and some are diagnosed with Irritable Bowel Syndrome, or IBS," he said. "It is estimated that one in 100 to one in 300 people have this disease and many don't know it."

Celiac disease is an autoimmune disease, meaning your own immune system works against you instead of for you. "Symptoms include recurrent diarrhea, constipation, puberty delay, poor appetite, abdominal pain, iron deficiency and abdominal distention. Not everyone will have these symptoms, and some people are asymptomatic," Cohan said. "The disease typically manifests between 10 and 40 years old." But this isn't something that you just "get." You must be genetically predisposed. The first problem for people with this disease is that many do not get the correct diagnosis. Certain tests must be done for a diagnosis, yet many people do not get tests done until they have been suffering for a while. "Serological blood tests are the first tests done," Cohan said. "Positive blood work would mean an upper endoscopy with six biopsies. The biopsy becomes the gold standard for diagnosis. That is essential to establish a diagnosis." When a person is diagnosed, his or her entire diet must change, and cheating is not wise. "The only cure is diet. It is a lifetime diet, free from all barley, wheat and rye. Cheating isn't an option. Cheating causes the symptoms to come back," Cohan said. "It is critical for a patient diagnosed with celiac to see a dietitian. The most common reason a patient will still have symptoms is because they do not realize that they are still consuming wheat, barley or rye. These things are in so many foods." And there is not a medication on the market that can help with this disease. "There is something in the pipeline that may become beneficial, but for now, there is no pharmaceutical cure," Cohan said.

The list of foods with gluten in them is a long one. Hot dogs, non-dairy creamer, cheese spreads, bouillon cubes, candy, processed canned meats, chips and dip mixes, ice cream and tomato sauce are just a few of the items that contain gluten. This could cause an issue for Catholics who go to church regularly and receive the host each week. The communion wafer also contains gluten.

The Web site www.celiacsofeasternpa.com has a restaurant guide to help avoid gluten when eating out. There are also other resources and support groups available online.

Other health issues bring up a red flag to be tested for celiac disease. They fall into a high-risk group for the disease. "People with Type 1 Diabetes, Down syndrome and someone with a first-degree relative with celiac disease should be tested," Cohan said. "Anybody with an iron deficiency should be tested, since celiac disease could be the potential cause of the deficiency." One big health problem that goes along with celiac disease is malabsorption. "The villi in the small intestines is where all absorption takes place. These villi are lost because of celiac, which reduces the absorption capacity substantially," Cohan said.

There is an increase of mortality with undiagnosed celiac disease. "There are plenty of people that walk around with this disease and have no idea," Cohan said. "One percent of all Americans have celiac."

For information on celiac disease, visit www.celiac.org, or www.americanceliac.org.

Celiac Disease/Gluten Intolerance, Food Allergies Intolerances/Sensitivities