Learning to Live With Celiac Disease
You may not know you have it, but celiac disease can rob the body of nutrients it needs to thrive.
Diagnosing celiac disease may be part of the problem.
"It can be very tricky," LaPook says. The first step is typically blood
tests looking for the presence and levels of certain antibodies. These tests
may include anti-gliadin, anti-endomysial, anti-tissue transglutaminase
antibodies, and total immunoglobulin A. If blood test results are positive, a
person will then go for a biopsy of the small intestine to confirm the
diagnosis and assess the degree of damage.
Sometimes blood tests are inconclusive, LaPook explains, and that's when we
test for specific HLA (human leukocyte antigen) genes associated with celiac
disease. If these genes are not present, it is unlikely that a person will
develop celiac disease. A positive HLA test, however, does not mean that the
individual has the condition, as these genes are common in the general
"About 30% of the general population has the genetic propensity for celiac
disease and yet only about 1% get it, so most people with the genetic
propensity don't have celiac disease, and the thinking is that there may be
something that unmasks it, like a virus or other factors that we don't
understand yet," LaPook says.
A diagnostic clue, however, is the presence of a skin problem called
dermatitis herpetiformis, which is marked by itching and blisters. This
typically goes hand-in-hand with celiac disease.
Should You Get Tested?
As far as who should get tested, anyone with symptoms should talk to their
doctor about getting a blood test -- and perhaps anyone with any of the
secondary conditions such as the brittle bone disease osteoporosis or
infertility, experts tell WebMD.
In fact, a recent study in the Archives of Internal Medicine
suggests that screening people with osteoporosis for celiac disease may help
improve treatment and reduce the risks associated with fragile bones.
In the new study of 266 postmenopausal women with osteoporosis and 574 women
without osteoporosis, nearly 4.5% of the women with osteoporosis tested
positive for celiac disease; only 1% of the women without osteoporosis tested
positive with blood tests. What's more, follow-up intestinal biopsies confirmed
celiac disease in 3.4% of women with osteoporosis and only 0.2% of women
without osteoporosis. And the more severe the celiac disease, the more severe
the osteoporosis, the study showed.
Onus Is on You
If your doctor doesn't bring celiac disease up, it's up to you. LaPook
suggests patients tell their doctors, "I was reading that it turns out thinking
about celiac disease has changed in the last 30 years and the symptoms can be
more subtle; I am wondering if I may have it. I hear it's a simple blood test
to do a screen for it."
"If they have one of a host of autoimmune conditions such as type 1
diabetes, Sjogren's syndrome ... they should raise the question of this
diagnosis with their doctor. And the only way to really demonstrate that you
don't have it is to test for it," Green says.
Celiac disease often occurs in people with other autoimmune diseases. In
fact, 8% to 10% of people with type 1 diabetes also have celiac disease, he