During World War II, a Dutch pediatrician named Willem Dicke noticed improvement in gastrointestinal symptoms among some of his patients when food shortages resulted in a deficiency of bread products, which were replaced with unconventional food stuffs.
When the patients' symptoms reoccurred upon reintroduction of bread after the war, it prompted Dr. Dicke and a colleague to design a series of experiments that confirmed that certain "toxic cereals" caused a disorder previously identified as celiac disease.
Also known as gluten-sensitive enteropathy and non-tropical sprue, celiac disease is very common primarily among people of northern European ancestry. It has been suggested that the prevalence of the disorder may be as high as 1 in every 250 Americans.
Celiac disease results from damage suffered by the digestive surface of the small intestine resulting from an immune response to the protein and gluten found in certain grains including wheat, barley and rye. This damage results in a problem known as malabsorption, in which some food passes undigested into the large intestine while certain vital nutrients are not absorbed into the bloodstream.
Celiac disease affects both children and adults. The symptoms of the disorder are highly variable and affect multiple body systems, not just the gastrointestinal system. In part because of this variability, the condition often goes undiagnosed and untreated.
Classic symptoms include bloating, flatulence and diarrhea as well as associated abdominal discomfort. Celiac sufferers are often misclassified as having an "irritable bowel."
These symptoms may be accompanied by the effects of poor nutrient absorption including impaired growth among children, weight loss, anemia and even neurologic problems resulting from lack of certain necessary vitamins.
Other symptoms can include depression and behavior changes, fatigue, menstrual irregularities among women, infertility in both genders and skin rash.
Long-term effects of celiac disease include increased risk for osteoporosis and certain types of cancer.
Celiac disease also is associated with a number of other conditions ranging from Type 1 diabetes to diseases of the liver, thyroid and heart.
The diagnosis of celiac disease often begins with blood tests that measure certain antibodies related to the condition. When these tests are positive or inconclusive in the setting of a strong suspicion for the disorder, a biopsy of the small intestine may be performed to confirm the diagnosis.
Genetic tests do not effectively predict who will develop celiac disease. Certain genetic tests are available that, if negative, typically exclude the disorder.
The treatment of celiac disease involves the removal of gluten from the diet. In the setting of a gluten-free diet, medication is typically not required.
Adapting to a gluten-free diet can be challenging, though there are many resources to help. People who wish to obtain more information should consult their doctor or access the Celiac Disease Foundation website at www.celiac.org.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Health Center in Towaoc.
source: durangoherald
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