There are many serologic tests for Celiac Disease but the results can be confusing. The blood study of tTG antibodies is specific for celiac disease. Tissue transglutaminase is an enzyme found in all tissues of the body and in People with Celiac it alters gliadins chains into a specific shape that sits on the surface of the HLA-DQ2 and DQ8 molecules causing the disease process. Another test is IgA endomysial antibodies but this test may be negative in patients under the age of two. One can also do a gluten challenge test but the definitive diagnosis of Celiac Disease is made with intestinal biopsy.
Four Categorical Complications of Celiac
There are four major categories of symptoms and complications in Celiac:
- Intestinal problems
- Manifestations of Malabsorption
- Systemic Inflammatory Reactions
- Autoimmune Disease and Malignancies
Symptoms of Celiac include diarrhea, cramps, bloating, lactose intolerance, increased reflux, dyspepsia, weight loss, vitamin deficiencies especially A, D, E, K, B12, Folic Acid and calcium. There is small bowel overgrowth with pathogenic bacteria, an increased risk of cancer and peripheral neuropathies.
In silent Celiac Disease many people recognize their symptoms and signs retrospectively. There is fatigue, dental enamel defects, irritability, depression and infertility. Gluten Sensitivity implies that the patient is sensitive to gluten without the underlying damage to the intestinal villi.
Celiac is a multi-system disorder. There are neurological manifestations, osteoporosis, malignancy, depression, dermatitis and other skin conditions, diabetes, infertility and other autoimmune diseases. Neurological manifestations can include neuropathy, brain atrophy, dementia and ataxia as well as seizures. Celiac patients are at high risk for the development of some cancers: thyroid, small intestine, lymphoma, esophageal cancer and melanoma.
A gluten free diet is protective against the development of cancer in Celiac patients. A common complication of Celiac is osteoporosis. At the time of diagnosis about 75% of the patients already have bone loss. Men with Celiac usually have a more severe case of bone loss. Osteoporosis in Celiac is caused by malabsorption of nutrients such as calcium, magnesium and vitamin D, secondary hyperparathyroidism, premature menopause and inflammation as well as autoimmunity.
The scope of this disease is huge and more effort must be made in the diagnosis and treatment.
See the next post in this series: Depression in Celiac Patients
See the previous post in this series: Exploring Celiac Disease