celiac disease

Celiac disease, or gluten-sensitive enteropathy, is a life-long digestive disorder caused by allergy to a protein found in products derived from wheat, rye, and barley (but not oats, as previously thought). It was previously thought to be fairly rare; one more recent study in the US put the actual prevalence at at least 1 in 150 Americans, and other studies suggest the true rate may be 1% of US and European populations.

There must be long term exposure to these grains before the problem develops. It appears usually between 6 and 24 months or so of age. While the condition is clearly genetically determined, other environmental factors must play a role in the development of the disease. For example, only 70% of identical twins both have the disease.

The disease itself is characterized by withering of the microscopic finger-like villi that comprise the lining of the small intestine. These projections dramatically increase the surface area of the small intestine, and make absorption of nutrients as efficient as possible. As they are lost (atrophy) the absorptive area of the small intestine is severely decreased. Hence food is not absorbed properly, which in turn causes malnutrition, diarrhea, and all the other manifestations.

Chronic diarrhea is the most common symptom. Symptoms also include failure to thrive, irritability, vomiting, poor appetite, foul stools, abdominal pain, excessive appetite, and rectal prolapse.

Diagnosis is by a blood antibody test and small bowel mucosal biopsy. Treatment consists of a strict gluten-free diet, which must be adhered to for life. All wheat, rye, and barley products are eliminated from the diet, generally with the help of a dietician.

The outlook for a child with celiac disease is good, as long as the diet is maintained. There are no adverse health effects from proper diet treatment. Teenagers are notorious for going off the diet; they do not realize that their growth and sexual maturation can be affected by the predictable reappearance of bowel damage.

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