Who should be screened for celiac disease?
By Jennifer Wood, Gundersen Lutheran registered dietitian
Everyone! As many as one in every 133 people may have celiac disease, which is an
autoimmune disorder effecting the absorption of nutrients from food. In celiac disease,
damage to the gut is caused by an immune reaction to gluten, a protein found in wheat,
rye, barley and in many processed foods as an additive. Celiac disease is a genetic disease
and runs in families so the incidence of occurrence in this population may be as high as
one in 22. Down syndrome also correlates with a higher incidence of celiac disease.
In many countries children are routinely screened for celiac disease. In the United States
routine screening is not done, therefore many people may have it and not know it.
Symptoms of celiac disease vary widely. Since symptoms are suggestive of other
stomach or bowel disorders, many people are often misdiagnosed. Common symptoms
include gas and bloating, abdominal pain, diarrhea or constipation, and pale, foul
smelling and/or fatty stools. Symptoms may also be vague and seemingly unrelated such
as fatigue, anemia, osteoporosis, bone or joint pain, rashes, seizures, gynecological
disorders, growth problems, dental problems, vitamin deficiency, and even behavioral
and neurological disorders. Some people have no obvious symptoms at all, yet are still at
risk for long-term complications from the disease.
Screening for celiac disease is a simple blood test checking for antibodies. A positive
blood test is followed by a biopsy of the small bowel for confirmation. However, some
people have negative antibody tests and still have a positive biopsy with subsequent
remission following a gluten-free diet. So, if symptoms don’t clear up, a biopsy may be
suggested even if the blood test was negative.
A common skin rash called dermatitis herpetiformis is also a common gluten-intolerance
disorder and can be confused with eczema. This skin rash clears up with a gluten
eliminating diet. Dermatitis herpetiformis is diagnosed through a biopsy of the rash.
Other common autoimmune diseases with a connection to celiac disease include thyroid
disease, lupus, type 1 diabetes, liver disease, vascular disease, rheumatoid arthritis and
Sjogren’s syndrome (dry eyes).
People who have celiac disease who don’t eliminate gluten from their diet are at
increased risk for lymphoma, gastrointestinal cancers and other malnutrition problems.
The National Institute of Health issued a celiac awareness campaign in 2005 to shed light
on this often undiagnosed or misdiagnosed disease. Despite this effort, it still takes more
than four years on average to get correctly diagnosed through symptoms alone. So,
everyone should get screened, especially those with a family history, to eliminate
needless treatments that stem from this underlying autoimmune disorder.
The only treatment for celiac disease is to follow a strict gluten-free diet. However it is
important not to start a gluten-free diet prior to being screened as this may cause a false
negative screen. For most patients, a gluten-free diet stops symptoms, heals existing
intestinal damage and prevents further damage. Although the gluten-free diet means
avoiding food made with wheat, rye and barley, other flours can be substituted in recipes.
People with celiac disease can eat meat, fish, fruits and vegetables. However, they must
watch for hidden gluten in sauces, gravy, salad dressings and processed food. A
registered dietitian can help with meal planning.