hgazette.com, Haverhill, MA

May 9, 2013

How to successfully deal with the digestive celiac disease

Bridget Jennings Seymour
MD

---- — The Gazette publishes occasional columns from local doctors. One appears below.

Haverhill residents have probably noticed a small store on Groveland Street across from Merrimack Valley Hospital called Just for Me Gluten Free.

The store opened in response to the needs of the many local people affected with celiac disease, a digestive disorder that occurs in reaction to gluten, a protein found in grains such as rye, barley, wheat and the hundreds of foods made with them.

When the body’s immune system reacts to gluten, it causes inflammation and destruction of the intestinal villi, finger-like projections that increase the surface area of the intestines for better absorption of nutrients.

Symptoms are numerous and similar to other disorders such as irritable bowel syndrome and lactose intolerance. Symptoms vary from person to person. Diagnosis can be comprised of several steps. A blood test for antibodies provides effective screening, which is later confirmed with a small bowel biopsy during endoscopy. Implementation of a gluten free diet with symptomatic improvement can also be suggestive of celiac disease.

Celiac disease patients vary in their tolerance of gluten. Some can ingest small amounts without symptoms, while others experience severe symptoms from the tiniest amount.

The severity of symptoms is affected by factors such as how much gluten is in the patient’s diet, how much damage was done before diagnosis, and the age of the patient when gluten was first introduced.

Celiac disease is fairly common.

Based on the largest U.S. studies comprised of more than 13,000 asymptomatic patients, one in every 133 patients has celiac disease, a number that I have seen replicated in my my Haverhill practice. This number increases to one in 22 for patients with first-degree relatives diagnosed with the disease.

Celiac disease is also associated with other autoimmune disorders such as thyroid disease, type 1 diabetes, autoimmune liver disease and skin disorders.

Standard treatment calls for a gluten-free diet to prevent intestinal damage and the malabsorption of nutrients, which can lead to health conditions such as anemia from lack of iron and osteoporosis from lack of calcium.

In children, symptoms can include signs of malnourishment, growth problems, failure to gain weight, decreased appetite, chronic diarrhea or constipation, vomiting, abdominal bloating and pain, fatigue and irritability. In teenagers, additional symptoms can be delayed puberty, depression, dermatitis, hair loss, dental problems and mouth sores.

When adults are diagnosed, they sometimes have osteoporosis and/or anemia, Although adults sometimes have fewer gastrointestinal symptoms, other symptoms include infertility, miscarriages, erratic menstrual cycles, bone or joint pain, arthritis, depression or anxiety, dermatitis and mouth sores.

To avoid gluten, remove the obvious foods such as regular breads, cereals, waffles, pancakes, bagels, pasta, cookies, cakes, muffins and pastries. But there are other hidden sources of gluten, so read the list of ingredients on the label of foods. Oats can be contaminated when processed in equipment that also processes wheat products.

Gluten is also commonly found in processed foods as a thickening or binding agent in canned soups and stews, salad dressings, ice cream, candy bars, instant coffee, processed meats, condiments, sausages, and even dairy products. Medicine and vitamin tablets commonly use wheat starch as a binding agent. Gluten is also found in makeup, lipstick and alcohol products.

Once on a gluten-free diet, many patients said their symptoms improved within a few weeks or even days, but complete improvement can take up to a year.

For children, the response can be dramatic: Diarrhea and abdominal discomfort subside, behavior improves and growth resumes. Improvements in symptoms are followed by reappearance of intestinal villi, though complete healing can take months. But in many adults, the improvement in symptoms is followed by only partial regeneration of the villi. Consultation with a nutritionist can also help patients manage their disease.

Even patients with mild symptoms should be treated to avoid possible long-term effects such as malnutrition, liver disease and cancer. People with celiac disease are felt to have a slightly higher risk of developing small intestinal lymphoma and adenocarcinoma than the general population.

Gastroenterologist Bridget Jennings Seymour, MD, is on staff at Merrimack Valley Hospital.