The Medical Minute: Celiac disease, or gluten sensitivity?

November 07, 2012

HERSHEY, Pa. -- Celiac disease, also known as gluten-sensitive enteropathy and sprue, is receiving a lot of attention in the popular media. Part of this is due to the fact that the disease is being diagnosed more frequently and recognition that it may not always be present with diarrhea, weight loss and malnutrition. There is also an emerging population of patients with intestinal symptoms who improve upon gluten withdrawal from the diet and do not meet the criteria for celiac disease, says Joel Haight, a gastroenterologist at Penn State Hershey Endoscopy Center in State College, Pa. These people are classified as having non-celiac gluten sensitivity.

Celiac disease is an immune disorder triggered by gluten (a protein found in grains) in genetically predisposed individuals. There is a loss of small intestinal villi, small finger-like projections that significantly increase the surface area for absorption of nutrients. Malabsorption results and can cause diarrhea, gas, bloating, foul-smelling stools, weight loss and a spectrum of associated conditions (including but not limited to anemia, osteoporosis, diabetes, peripheral neuropathy, skin rashes, abnormal liver tests, infertility, miscarriages and mouth ulcers). It is estimated that as many as 1 in 250 Americans may have celiac disease. The disease is more common in people of northern European descent but can be found in other races and locales, particularly India. Females outnumber males about three to one.

Haight says there is no single test to definitively diagnose or exclude celiac disease in every person, but it is imperative that diagnostic tests for celiac disease be performed while the patient is on a gluten-containing diet. A specific and sensitive blood test helps screen suspected patients for celiac disease. Patients with a positive test, or a negative test but a high clinical suspicion, should have a small bowel biopsy.

Once the disease is diagnosed, treatment includes a strict, lifelong gluten-free diet. This includes the elimination of wheat, barley, rye and oats not labeled gluten-free. Other ingredients that may contain gluten are malt, dextrin, brewer’s yeast and starch. Consultation with a registered dietician familiar with the disease is highly recommended, Haight says.

“In many circles, gluten is being viewed as the new dietary villain,” Haight says. “Many patients are placing themselves on trials of self-imposed gluten-free diets. Some of them feel better and may have non-celiac gluten sensitivity. The problem is that symptom resolution on a gluten-free diet is not sufficient to diagnose celiac disease.”

Furthermore, he says, a gluten-free diet invalidates the standard tests for celiac disease, and there are no accepted tests for non-celiac gluten sensitivity. Ultimately, a gluten challenge for several weeks may be necessary to work through the diagnostic steps, Haight says.

“Although there are no known adverse nutritional outcomes from a gluten-free diet, it is best to consult with your physician first and establish a correct diagnosis before committing to a strict, life-long dietary change,” he added.

The Medical Minute is a weekly health news feature brought to you by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Up next week: Tips for people with chronic health concerns like diabetes for navigating the food-focused winter holiday season without the feelings of guilt or deprivation.

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Last Updated November 12, 2012