Medical Edge Newspaper Column

Celiac Disease Often Goes Unsuspected, Undiagnosed

December 24, 2007
Dear Mayo Clinic:
I was diagnosed with celiac disease after two years of misery, including chronic diarrhea, abdominal pain and losing 23 pounds over 5 months. I understand this is a fairly common problem and that it is underdiagnosed. I'm doing much better now, but can you give me more information about this disease?

Answer:
It's good to hear you are managing your condition. After diagnosis, most people with celiac disease feel well within a couple of months if they strictly adhere to a gluten-free diet.

Some background: Celiac disease, a digestive disorder triggered by the protein gluten, is increasingly recognized as a common condition. An estimated 1 percent of the population has celiac disease, but many haven't yet been diagnosed.

When people with celiac disease eat foods derived from wheat, barley or rye, it triggers an immune reaction in the small intestine. The reaction damages the surface of the small intestine and prevents the absorption of certain nutrients. Left untreated, it can result in malnutrition, osteoporosis and increased risk of some cancers.

There's no one set of symptoms for celiac disease. Symptoms can include abdominal pain, diarrhea or bloating, which initially may point to other disorders that are either more common or more familiar to doctors, for example, irritable bowel syndrome or Crohn's disease. This may have been your situation. Symptoms of celiac disease also can be subtle and not obviously related to digestive problems, such as anemia, headache, liver abnormalities, premature osteoporosis, infertility and tingling in the legs and feet, to name a few.

Once celiac disease is suspected, a positive blood test for specific antibodies points to an increased likelihood of celiac disease. A diagnosis is confirmed with a biopsy to check for damage in the small intestine.

Researchers haven't found a cause of celiac disease. It can run in families and is more common in Caucasians and Hispanics. It sometimes emerges after physical or mental stress caused by infection, injury, pregnancy or surgery.

While there's no cure for celiac disease, it can and should be managed with a gluten-free diet. Avoiding gluten is challenging  especially when traveling, eating out, or for children eating at school. Gluten is in many prepared and packaged foods.

I urge patients to work with a dietitian experienced in celiac disease and to seek out a support group to share ideas and information. Increasingly, some packaged foods are available gluten-free. While challenging to follow, a gluten-free diet can be nutritionally complete and include meat, poultry, fish, most dairy products, fruits, vegetables and rice.

There are excellent resources on the Web to learn more about celiac disease. Two sites that I recommend are MayoClinic.com and the National Digestive Diseases Information Clearinghouse . On both sites, search "celiac."

-- Joseph Murray, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.