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Guide: Celiac Disease


"Celiac" comes from the Latin word for abdomen, but this digestive disease can cause symptoms throughout the body. Celiac Disease:

Villi 

Wheat-based foods -- from a bagel for breakfast to pasta for dinner -- are a dietary staple for many people. But for a person with celiac disease, nibbling even a crumb of toast can spell trouble. Celiac disease (also known as celiac sprue) is an inherited intolerance to gluten, the sticky protein found in grains such as wheat, barley, and rye. For people with this condition, eating gluten can trigger immune system attacks that may ravage the lining of the small intestine, causing symptoms that include abdominal pain and bloating, diarrhea, and fatigue. Because the injured intestine can't adequately absorb vital nutrients (such as iron, calcium, and vitamin D), untreated celiac disease can lead to iron deficiency anemia, osteoporosis, lactose intolerance (the inability to digest or absorb lactose, a sugar found in milk and other dairy products), and other problems.

Celiac disease was once thought to be rare, but experts now estimate that in the United States, about 1 in 100 people -- five million in all -- have the disorder. It's more common among people of European ancestry (especially those from Italy, Ireland, and the Scandinavian countries), and it's slightly more prevalent in women.

Anatomy of celiac disease

The small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In a healthy intestine, they resemble the rough surface of a shag carpet. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed. Sometimes only a small portion of the intestine is affected. That's why some people with celiac disease have few or no symptoms and no signs of nutrient deficiencies.Not always obvious

Celiac disease often goes undiagnosed because its classic symptoms resemble those of other common ailments, such as irritable bowel syndrome and lactose intolerance. Two other bowel disorders, Crohn's disease and ulcerative colitis, are perhaps more familiar than celiac disease, but celiac disease is more common than both of them combined.

Another reason for misdiagnosis is that one-half to two-thirds of celiac patients don't have gastrointestinal complaints; instead, they show signs of anemia or fatigue. Celiac disease is usually identified only after no other causes, such as internal bleeding, are found for these symptoms.

These difficulties help explain why it takes an average of 11 years to be diagnosed with celiac disease after the symptoms first appear. Many people assume that the disease is diagnosed as soon as a child starts eating foods that contain gluten, but that's not the case. Celiac disease can develop at any time in life, including old age. Also, people with a genetic predisposition for gluten intolerance don't necessarily manifest symptoms of the disease. Researchers describe this phenomenon as "the celiac iceberg" (see illustration).

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