Celiac disease is a disorder in which your body attacks normal tissue in the presence of gluten. Gluten is a protein found in wheat, barley or rye. Repeated gluten exposure leads to chronic inflammation that can damage the lining of your small intestine. This makes it difficult for your body to absorb the nutrients you need to stay healthy.
Most people with celiac disease have gene pairs that encode for at least one of the human leukocyte antigen (HLA) gene variants, or alleles, designated HLA-DQfound in 95 percent of people with the disease and HLA-DQ8. However, these alleles are found in about 30 to 35 percent of Caucasians, and most people with the variants do not develop celiac disease.1Negative findings for HLA-DQ2 and HLA-DQ8 make current or future celiac disease very unlikely in patients for whom other tests, including biopsy, do not provide a clear diagnostic result. An increased risk of developing celiac disease has recently been described in individuals who carry a new HLA-G I allele in addition to HLA-DQ2.
Commonly, people with celiac disease are deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as in calories and protein. Deficiencies in copper and vitamin B6 are also possible, but less common. After treatment with the gluten-free diet, most patients’ small intestines recover and are able to properly absorb nutrients again. However, patients may continue to be vitamin B deficient as the gluten-free diet may not provide sufficient supplementation. This can be remedied with a daily, gluten-free multivitamin. The multivitamin should not exceed 100% of the daily value (DV) for vitamins and minerals. Calcium and vitamin D supplementation may also be prescribed by your physician if your intake is not sufficient.
For adults, your physician should order a bone density test at time of diagnosis to test for osteopenia/osteoporosis (thin bones). A bone density test may also be ordered for children and adolescents who have experienced severe malabsorption, a prolonged delay in diagnosis, have bone disease symptoms or are non-compliant with the gluten-free diet. If you are at high-risk for bone fracture, you will be prescribed dietary supplements and medication to correct this.
A new generation of tests that use DGP antibodies has sensitivity and specificity that is substantially better than the older gliadin tests. However, based on a meta-analysis of 11 studies, insufficient evidence exists to support the use of DGP over tTG or EMA tests. The tTG test is less expensive than the DGP test and offers better diagnostic performance.
CD-associated costs indicate a significant economic burden of disease, particularly for diseased males. Diagnosis and treatment of CD reduces medical costs of care suggesting an economic advantage to earlier detection and treatment.
