Celiac Disease (cont.)
Bhupinder Anand, MD
In this Article
Can cancer risk be reduced in celiac disease?
Some doctors believe that strict adherence to a gluten free diet can reduce the risk of cancer in individuals with celiac disease, but further studies are needed to prove this. Until more is known in this area, persons with celiac disease should adhere strictly to a gluten free diet.
What's new in celiac disease?
The way in which gluten and gliadin cause disease appears to be complex. It does not appear to be simply a matter of an immune response to gliadin. Current information suggests that partially digested gliadin from the intestine is altered by tissue transglutaminase in the small intestine. These altered products of gliadin digestion are what provoke the immunologic response that leads to the production of antibodies to tissue transglutaminase and the inflammation that destroys the villi.
The symptoms of celiac disease can be similar to those of irritable bowel syndrome (IBS), and the issue often arises if patients with IBS need to be screened for celiac disease. If they are screened, should they be screened with blood antibody tests, small intestinal biopsies, or both? One study in particular has addressed this issue. Approximately 100 patients thought to have diarrhea from IBS were studied. Among the IBS patients, none had celiac disease-associated antibodies in their blood, but 30% had the antibodies in the juice obtained from within the duodenum. Twenty-three percent of the patients with IBS had lymphocytes in the lining of the small intestine just like patients with celiac disease. Finally, 35% of the IBS patients had the genes that are commonly found in celiac disease. These interesting findings need to be confirmed by additional studies. If confirmed, they would suggest that a proportion of patients with IBS may actually have celiac disease, and that the diagnosis might require small intestinal biopsy and antibody studies of the duodenal juice.
Another confusing issue is the fact that many people state that their gastrointestinal symptoms have improved by eliminating gluten from their diet despite the fact that all of the blood tests for celiac disease are negative and, in some cases, even the biopsies of the small intestine are normal. There are two possible explanations for this. The first is a placebo effect, that is, people think they feel better but they probably are not better. (It is sobering to know that this placebo response may occur in as many as 20% to 40% of people.) The other explanation is that gliadin-containing grains also contain fructans, complex carbohydrates that are not digested in the human small intestine. These fructans enter the colon where colonic bacteria can ferment them. The products of fermentation can give rise to gastrointestinal symptoms, particularly bloating, gas and diarrhea. It is not clear how many people who feel better by eliminating gluten from their diet have intolerance to fructans rather than celiac disease.
Medically Reviewed by a Doctor on 8/12/2013
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Celiac Disease - Symptoms Question: The symptoms of celiac disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
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