How to Test for Celiac Disease
Celiac disease is thought to affect 0.5% to 1% of people around the world, but despite being relatively common, it often goes undiagnosed. Even in cases where symptoms are present, it is often mistaken for other conditions and, as a result, many people have celiac disease for years without realizing they have a problem. The only way to truly find out if you have this disease is through testing. Here is how to test for celiac disease.
When left untreated, celiac disease can cause extensive damage to the small intestine which, in turn, leads to other serious health problems.
Identifying risk factors for the condition and learning how to recognize the symptoms (in both children and adults) can significantly aid diagnosis, which is usually performed by blood testing and an endoscopy examination of the small intestine.
What Is Celiac Disease?
Celiac disease (more commonly known as gluten intolerance) is a serious autoimmune condition affecting the small intestine. What is gluten? Gluten is a protein found in wheat, barley and rye. When people with celiac disease eat gluten, their body’s immune system attacks their small intestine. This causes damage to the lining of the small intestine and, if left untreated, can lead to malnutrition and other severe health complications.
The symptoms of celiac disease are often like those of other digestive issues, such as irritable bowel syndrome (IBS). In the case of silent celiac disease, patients may experience no symptoms at all. As a result, celiac disease can be tricky to diagnose, and many people can have the condition for years without realizing it. Though celiac disease can be effectively managed with a strict gluten free diet, some of the complications caused by long term damage to the small intestine may be irreversible.
What Are the Different Types of Celiac Disease?
Celiac disease can be divided into three main forms: classical, non-classical and silent celiac disease.
Classical Celiac Disease
Classical (typical or intestinal) celiac disease is usually detected in infants under the age of three and is characterized by symptoms affecting the digestive system. These may include diarrhea, constipation, abdominal pain and bloating, vomiting and weight loss.
Non-classical Celiac Disease
Also known as atypical or extraintestinal celiac disease, people with this form of celiac will experience few or no gastrointestinal symptoms. Instead, non-classical celiac disease is characterized by symptoms affecting other parts of the body.
Silent Celiac Disease
Also known as asymptomatic celiac disease, silent celiac disease is so-called because it usually does not cause any symptoms. Though often undetected, this form of celiac disease still causes damage to the villi in the small intestine.
The symptoms of celiac disease usually affect the digestive system, though they may also affect other areas of the body. Symptoms are often different for children and adults.
Symptoms of celiac disease in children include:
- Persistent diarrhea or constipation
- Abdominal bloating or pain
- Stools that are fatty, foul smelling and pale in color
- Weight loss
Adults with celiac disease may experience some or all of the gastrointestinal symptoms. Additionally, they will usually have symptoms that affect other parts of the body, including:
- Skin disorders
- Discoloration of teeth
- Loss of tooth enamel
- Pale sores inside the mouth
- Tingling or numbness in the hands and feet
- Brittle bones
- Stiff, painful joints
- Irregular menstruation
- Dermatitis herpetiformis (an extremely itchy rash of bumps and blisters that may develop on the elbows, knees or buttocks. DH is present in 15% to 25% of celiac cases and usually occurs in the absence of gastrointestinal symptoms). This is sometimes referred to as a celiac disease rash.
Who Is at Risk of Developing Celiac Disease?
Celiac disease is a genetic condition and you are more likely to have it if:
- You have an immediate relative with celiac disease
- You have Down’s syndrome
- You have Turner syndrome
- You have type 1 diabetes
- You have rheumatoid arthritis
- You have Addison’s disease
- You are Caucasian
What Is the Test for Celiac Disease?
Celiac disease is often diagnosed in two steps. First, your doctor will perform a blood serum and genetic test to determine the presence of certain antibodies and genes. If the results of these tests indicate that you have celiac disease, they may then perform an endoscopy to get a better look at your small intestine.
Blood Serum Testing for Celiac Disease
The tTG-IgA test is used to check for the presence of certain antibodies in the blood. In people with celiac disease, the levels of these antibodies will be much higher. This is considered to be the most sensitive test currently available for celiac disease. This test is only accurate if you are on a diet that contains gluten.
Genetic Testing for Celiac Disease
Genetic testing can be used to rule out celiac disease by finding out if you are a carrier of the HLA-DQ2 or the HLA-DQ8 genes. If you do not have either of them, then it is highly unlikely that you have celiac disease.
If your blood and genetic tests indicate that you have celiac disease, the next step is usually to perform an endoscopy. This involves the insertion of a camera attached to a thin, flexible tube into the small intestine, usually via the mouth. This allows the doctor to make a visual inspection of the small intestine, to remove a tissue sample for further analysis.
For a capsule endoscopy, the patient swallows a vitamin sized capsule containing a tiny, wireless camera. This then travels through the entire digestive tract, taking pictures all the way. The doctor can then use these photographs to examine the whole length of the small intestine.
Celiac Disease Treatment
The only way to treat celiac disease is with a strictly gluten free diet. You might be wondering what foods have gluten. Gluten free means a strict elimination of all foods that contain barley, wheat and rye. This will prevent further damage to the small intestine and can help to heal existing damage, improving the symptoms of celiac disease in a matter of days or weeks.
Long Term Complications of Untreated Celiac Disease
Celiac disease is often left undiagnosed and untreated for years. The damage to the small intestines over this time frame can be extensive and can lead to further complications including some of the following.
The damage to the small intestine may lead to lactose intolerance, characterized by abdominal discomfort and diarrhea after eating dairy products. This may be resolved once you start eating a gluten free diet and your intestine begins to heal.
The damage to the lining of the small intestine caused by celiac disease can impact your body’s ability to absorb nutrients. If left untreated, this can lead to deficiencies in the following vitamins and minerals:
- Vitamin B12
- Vitamin D
- Weak or brittle bones: long term calcium deficiency as a result of celiac disease can put you at greater risk of developing osteoporosis (weakened bones) or osteopenia (low bone density).
- Anemia: celiac disease can lead to an iron deficiency, which your body needs to make red blood cells. This can cause anemia and leave you tired and short of breath.
Infertility and Miscarriage
Women with untreated celiac disease may have trouble getting pregnant. They may also be more likely to miscarry.
Nervous System Problems
Some people with celiac disease experience complications relating to the nervous system. This may cause seizures or problems with movement.
People with untreated celiac disease are at a greater risk of developing T-cell lymphoma, non Hodgkin’s lymphoma and adenocarcinoma of the small intestine. However, developing cancer as a result of celiac disease is quite rare.
Celiac disease is thought to affect up to 1% of the population yet remains undiagnosed for years in many cases. The difficulty in getting people to test for celiac disease means that the damage to the small intestine often goes on for years before it is addressed and can lead to several other serious health conditions. These include problems with the nervous system, osteoporosis, infertility and miscarriage, and (rarely) certain types of cancer.
If you think you may have celiac disease, schedule an appointment with your doctor who will perform a series of diagnostic blood tests and examinations to confirm it. Once gluten is eliminated from the diet, patients usually see a significant reduction in symptoms and the small intestine can begin to heal.
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