US Pharm. 2012;37(12):13-14.
Intolerance to Gluten
Celiac disease is a disorder caused by an immune reaction
when gluten, a grain found in many foods and beverages, is consumed. The
specific result of the body’s immune response to gluten is damage to
the tiny villi that line the small intestine. Villi allow the absorption
of important nutrients in food as it travels through the
gastrointestinal (GI) system. When food is not absorbed properly,
symptoms such as diarrhea, cramping, and bloating can occur. If left
untreated, celiac disease, can lead to chronically poor absorption of
many important vitamins, minerals, and other nutrients that can result
in anemia, osteoporosis, dental problems, and neuropathies (pain and
tingling in the legs, feet, arms, and hands). Celiac disease in
childhood is a special problem because it can also lead to stunted
growth and development.
Gluten is a protein found in wheat, including semolina and
durum, as well as in related grains such as rye, barley, and triticale.
These grains are present in many foods and beverages and must be
avoided in people with celiac disease to prevent the immune reaction
that causes intestinal damage. Once all gluten-containing products are
avoided, the damaged villi in the small intestine begin to heal. Over a
period of months to a few years, the villi are able to properly absorb
nutrients again. With a gluten-free diet, GI symptoms in a patient with
celiac disease are often relieved quickly, although the disease is not
cured, and gluten must be avoided throughout the patient’s lifetime.
Patients With Celiac Disease Must Avoid Gluten
Celiac disease, also known as gluten intolerance, gluten-sensitive enteropathy, or celiac sprue,
can occur anytime during childhood or adulthood. It is more common in
Caucasians of European ancestry and in people with a family history of
celiac disease. Patients with type 1 diabetes, Down syndrome, or
autoimmune diseases such as lupus, Sjögren’s syndrome, rheumatoid
arthritis, or autoimmune thyroid disease have an increased risk of
Nonspecific Symptoms Complicate Diagnosis
Many people with celiac disease are not aware of the cause
of their symptoms because symptoms are not very specific and can be
caused by many conditions. A wide variety of symptoms can accompany
celiac disease, including diarrhea, constipation, abdominal cramping,
bloating and gas, foul-smelling or floating stools, weight loss,
fatigue, and a change in appetite. Some patients with celiac disease may
have problems digesting dairy products (lactose intolerance). Celiac
disease can also be accompanied by an itching skin rash, with or without
gastrointestinal (GI) symptoms, known as dermatitis herpetiformis.
As a result of the general nature of these symptoms, it
may take a significant period of time before the proper diagnosis is
made. Ultimately, the diagnosis of celiac disease is often a result of
ruling out other causes of GI symptoms, combined with information from
the patient on the history of symptoms and family history of celiac
disease. Blood tests can be used to measure antibodies the body forms to
attack gluten proteins. Additional tests include the examination of a
biopsied tissue from the small intestine or examination of the small
intestinal lining with a tiny camera that is swallowed.
A Gluten-Free Diet Relieves Symptoms
Although celiac disease does not have a cure, it can be
well managed by diet. Treatment for celiac disease is complete avoidance
of gluten-containing foods. If strictly followed, a gluten-free diet
results in the elimination of symptoms and the eventual healing of the
small intestinal wall lining. A dietician is often the health care
professional who supplies the patient with a comprehensive list of
foods, beverages, nutritional products, and drugs that contain gluten,
along with a list of gluten-free products. This list should also include
gluten-free toothpastes, mouthwashes, and lipsticks, which can possibly
enter the digestive tract.
Complications from celiac disease that is not well managed
can be serious. The chronic immune response and small intestinal wall
damage can lead to complications such as malnutrition, lactose
intolerance, intestinal cancer, liver disease, anemia, low blood sugar,
miscarriage, nerve damage, and weakened bones and teeth.
As more people are discovering that their GI symptoms are a
result of celiac disease, more gluten-free products are becoming
available and are clearly labeled as “gluten free” on their packaging.
Recently, grocery stores have established gluten-free sections and
restaurants are labeling menu items as “gluten free.” These conveniences
are making it easier for people with celiac disease to eat a wider
variety of foods.
If you think you might have celiac disease, see your
doctor. Do not begin a gluten-free diet prior to evaluation, because
avoiding gluten can affect the diagnostic tests for celiac disease. Your
pharmacist can tell you which drugs, OTC medications, or nutritional
supplements contain gluten and should be avoided.
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