Can you develop celiac disease later in life?
Celiac disease is commonly diagnosed between ages 10 and 40 years old, but it can be diagnosed in both infancy and later in life. Celiac disease’s symptoms can be confused with diseases like irritable bowel syndrome (IBS), but it’s important to get the right diagnosis because, left untreated, celiac disease can lead to serious health problems.
What is celiac disease?
Celiac disease, which affects about 1 in 100 individuals, is an autoimmune inflammatory small bowel disorder caused by a sensitivity to dietary gluten — a protein found in wheat, rye and barley. Patients with celiac disease are genetically predisposed, resulting in their body attacking the small intestine when it encounters gluten. Continue reading to learn what symptoms to look out for, available treatments, and common misconceptions to ensure patients receive the appropriate care.
Common symptoms of celiac disease in children and adults
Symptoms of celiac disease can vary from person to person. Some of the more commonly seen indicators include digestive problems, including:
- Chronic diarrhea
- Weight loss
- Recurrent abdominal pain
These symptoms are experienced by both children and adults with celiac disease. Additional symptoms specific to children include behavioral symptoms (e.g., irritability/difficulty concentrating), failure to thrive, short stature, amenorrhea and delayed puberty.
About 15-25% of people with celiac disease have a skin rash called dermatitis herpetiformis that’s characterized by itchy blisters typically on the elbows, knees and buttocks.
Other extraintestinal manifestations (conditions that occur outside your gastrointestinal tract) suggestive of celiac disease can be vague and include any of the following:
- Iron deficiency anemia
- Peripheral neuropathy (damage to the nerves located outside of the brain and spinal cord)
- Oral lesions
- Elevated liver enzymes
Like adults, children can have joint pains, fatigue, iron deficiency anemia, mouth sores, osteopenia, vitamin deficiencies, malnutrition and dermatitis herpetiformis.
How is celiac disease diagnosed?
The best serologic test (a lab test that checks for the presence of antibodies or other substances in a blood sample) to screen for celiac disease is called tissue transglutaminase-immunoglobulin A (tTG-IgA). Tissue transglutaminase is an enzyme that fixes damage in your body. Individuals with celiac disease often make antibodies that attack this enzyme.
If you have an IgA deficiency, then testing with deamidated gliadin peptide-immunoglobulin G (DGP-IgG) is recommended to diagnose celiac disease. This test is also often used to diagnose infants younger than 2 years old.
It’s important to note that patients need to be ingesting gluten at the time of testing to ensure accuracy. If you’re on a gluten-free diet at the time of testing, then the test could be a false negative.
If the blood test is positive, then you would undergo an upper endoscopy to obtain biopsies of the small bowel to confirm the diagnosis.
Celiac disease treatment
Currently, the only available treatment for celiac disease is a strict gluten-free diet. Inadvertent gluten ingestion is common due to food contamination at restaurants and gluten hidden in unexpected products such as lipstick. It is important for people with celiac disease to meet with a dietitian soon after being diagnosed so that they can be successful with their gluten-free diet.
In most people, following a gluten-free diet heals any existing intestinal damage from celiac disease and prevents further damage.
Here at Ohio State, we monitor each patient’s response to treatment by trending their tTg-IgA levels. There is a very small subset of people with celiac disease who have refractory sprue, which is when the disease is not controlled despite a completely gluten-free diet. In these cases, immunosuppression medication is added to their treatment (such as steroids, immunomodulators or biologics). However, most of the time the problem is actually caused by inadvertent gluten exposure. True refractory sprue is uncommon.
What’s causing the increase in celiac disease diagnoses?
There are studies showing an increase in incidence of celiac disease over the past several decades, with an average of 7.5% per year. Some possible explanations include the introduction of serologic blood testing toward the end of the 20th century, and increased awareness of the disease among physicians. We’ve been increasingly improving our detection of celiac disease.
Is it really celiac disease, or something else?
Because celiac disease causes non-specific gastrointestinal complaints, it can be mistaken for irritable bowel syndrome (IBS). It is recommended that everyone with celiac symptoms undergo celiac testing before getting a diagnosis of IBS.
Other diseases that could cause similar symptoms as celiac disease include microscopic colitis, lactose intolerance, small intestinal bacterial overgrowth, chronic pancreatitis and inflammatory bowel disease.
If you’re experiencing some of the symptoms listed above, contact your primary health care provider to determine the best approach for your health concerns.