From Mary Kugler, R.N.,
Your Guide to Rare Diseases.
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It can come on at any age, from infancy to late eighties. The symptoms are different in different people, and it may be misdiagnosed as food allergy or lactose intolerance. Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is an autoimmune disorder affecting the digestive system. When a person with celiac disease eats food containing gluten, a common protein in cereal grains, antibodies (normally used by the body to fight diseases) attack the lining of the small intestine and cause damage. Why this happens is not yet known. The small intestine then can't properly absorb basic nutrients such as proteins, fats, vitamins, and minerals.

Who gets it?
In the past, celiac disease was thought to occur mostly in white European people in countries such as Ireland, France, and Italy, affecting one in every 2000 people there. Doctors in the United States thought it was relatively rare in their country, maybe only one case in every 5,000 white people of European descent. However, new tests and studies suggest that as many as one in every 133 people in the U.S. may be affected, and that celiac disease affects people of all ethnic backgrounds. The tendency to develop celiac disease is genetically inherited in families.

What are the symptoms?
Common symptoms include:

• Abdominal cramping, intestinal gas, distention, bloating
• Chronic diarrhea or constipation, or both
• Steatorrhea (oily stools from fats not being absorbed)
• Anemia (due to iron and B vitamins not being absorbed)
• Fatigue, weakness, and lack of energy

How is it diagnosed?
If a person is having symptoms which suggest celiac disease, a blood test can be done that looks for the specific antibodies involved in the disease. If this test comes back positive (high levels of the antibodies were found), the next step is to take a sample (biopsy) of the small intestine to look for damage caused by the disease.

Also, there are some other clues that can point to the diagnosis, such as the presence of a blistering, itchy skin rash known as dermatitis herpetiformis. It is now known that 100% of people with this skin disorder also have intestinal problems with gluten.

How is it treated?
Unfortunately, there is no cure for celiac disease, but it can be effectively treated by the person not eating anything with gluten in it. Within 3 to 6 days after starting a "gluten-free" diet, the lining of the small intestine begins to heal, and after about 3 to 6 months, the intestine will be back to normal.

Although it sounds simple to say, spending the rest of one's life not eating anything containing gluten can be difficult. Having someone in a family or household on a special diet can be challenging, especially since gluten is found in wheat, rye, barley, and a little in oats. (Rice and corn have no gluten.) However, there are cookbooks and recipes available that (tastily) overcome these restrictions.

In addition, gluten is found in many processed foods where it is used as an inexpensive filler (listed under "modified food starch" and other names). Gluten may even be found in unexpected items such as hard candies, jelly beans, gum, and lipstick. Fortunately, organizations such as the Celiac Disease Foundation and Celiac Sprue Association provide complete lists of acceptable foods for a gluten-free diet, as well as support and resources.

Sources:
- Atkins, Kimberly. "With celiac disease, Swift and others become food detectives." The Boston Globe, August 21, 2001.
- Celiac Sprue Association.
- Celiac Disease Foundation. "About Celiac Disease."