Celiac Disease: A Risk Analysis

Celiac disease is the only autoimmune disease with a known cause and can be reversed by eliminating gluten protein.

What is Celiac Disease?

Celiac Disease (“Celiac”) is a disease of the digestive system that damages the small intestine and interferes with the absorption of nutrients from foods.[1] It is one of the most common diagnosed autoimmune disorders.[2] Fortunately, more research on the disease is coming to light which involves. In my risk analysis, you’ll learn that certain viruses are the cause with a genetic influence in 95 percent of people with Celiac.

Cause or Possible Cause of Celiac Disease

Celiac results from an immune reaction to gluten which is a protein substance presently found in cereal grains such as wheat, barley, and rye. It is the most severe form of gluten intolerance.[3] Studies have shown Celiac to be linked to viruses in the gut, especially enteroviruses and reoviruses.[4][5][6] Longitudinal studies have also determined childhood infections of rotavirus (one of 9 reovirus genera) lead to Celiac.[7][8] For children diagnosed with Celiac under the age of two, studies reveal a strong susceptibility due to contracting respiratory syncytial virus (RSV) or any viral bronchiolitis infection.[9]

What Celiac Disease Does to the Body

When gluten-filled foods are eaten, an inflammatory response occurs in the small intestine which damage tissues. The result is an impaired ability to absorb nutrients from food which can cause malnutrition. While the small intestine can suffer extensive damage, the inflammatory response also triggers numerous symptoms.[10] In fact, there are more than 300 symptoms of Celiac reported. However, there may not be any symptoms at all, though intestinal damage will occur if gluten is ingested.[11]

The most common symptoms of Celiac relate to the improper absorption of food in the gastrointestinal system. These symptoms may include abdominal bloating and pain, chronic diarrhea, vomiting, constipation, and pale, foul-smelling, or fatty stool.[12]

Other common symptoms of Celiac include anxiety or depression, fatigue, irritability, headaches or migraines, tingling or numbness, pale mouth sores, discolored teeth, joint pain, thin bones, itchy skin rash (dermatitis herpetiformis), anemia, infertility, delayed growth in children, and poor weight gain.[13]

What Happens as Celiac Disease Progresses

If Celiac is left untreated, adverse health consequences and increased mortality is a result. There is an increased risk for malignancies such as small bowel adenocarcinoma, cancer of esophagus, B-cell and T-cell non-Hodgkin lymphomas, and especially T-cell lymphomas.[14] Occurrence of thyroid epithelial cancer is 2.5-fold in people with Celiac.[15]

Aside from cancer, severe conditions are associated with Celiac if left untreated:

  • low bone mineral density and risk for fractures[16]
  • infertility, spontaneous abortions, preterm deliveries, and delivery of low birth weight infants (women)[17]
  • thrombosis (elevated serum level of antiphospholipid antibodies)[18]
  • atherosclerosis, ischemic heart disease, and stroke[19]
  • epilepsy[20]
  • cerebella ataxia, peripheral neuropathy, seizures, headaches, cognitive impairment, and neuropsychiatric diseases[21]
  • organ disorders (pancreas, gallbladder, liver, spleen)[22][23][24][25]
  • mitochondrial oxidative stress[26]
  • other autoimmune diseases[27]

Risk Influence for Celiac Disease

Celiac has a genetic basis and can run in families. However, the pattern of inheritance in complicated. The type of inheritance pattern is multifactorial (caused by many factors including genetic and environmental). Because Celiac has a hereditary influence, close relatives have a higher risk of being affected with the condition. The chance of a first degree relative having the disease is 10 percent.[28] About 95 percent of people with Celiac have the HLA-DQ2 gene, and the majority of the remaining five percent have the HLA-DQ8 gene. Both HLA-DQ2 and HLA-DQ8 are the requisite genes for Celiac.[29]

Treatment for Celiac

The only current treatment for Celiac is a lifelong gluten-free diet. There is no pharmaceutical treatment.[30]

Conclusion

While my risk analysis does factor in viruses and genetic influences, another element to be discussed later is “genetically modified foods,” also known as “GMOs.” Because Celiac isn’t the only disease that GMOs affect, it is a topic that needs to be discussed in its own article.

References

[1] Celiac Disease. (n.d.). The Free Dictionary by Farlex (Medical Dictionary). Retrieved from https://medical-dictionary.thefreedictionary.com/celiac+disease.

[2] Majsiak, E., Cichoz-Lach, H., Gubska, O., et. al. (2018, January 23). Celiac Disease – Disease of Children and Adults: Symptoms, Disease Complications, Risk Groups and Comorbidities. Polski Merkuriusz Lekarski Polish Medical Journal, 44(259), 31-35. Retrieved from http://medpress.com.pl/pubmed.php?article=25931.

[3] Ibid.

[4] Kemppainen, K., Lynch, K. & Liu, E., et. al. (2017, May). Factors That Increase Risk of Celiac Disease Autoimmunity After a Gastrointestinal Infection in Early Life. Clinical Gastroenterology and Hepatology, 15(5), 694-702(e5). Doi: 10.1016/j.cgh.2016.10.033. Retrieved from http://www.cghjournal.org/article/S1542-3565(16)31043-6/fulltext.

[5] Vorobjova, T., Raikkerus, H., Kadaja, L., et. al. (2016, December 19). Circulating Zonulin Correlates with Density of Enteroviruses and Tolerogenic Dendritic Cells in the Small Bowel Mucosa of Celiac Disease Patients. Digestive Diseases and Sciences, 62(2). 358-371. Doi: 10.1007/s10620-016-4403-z. Retrieved from https://link.springer.com/article/10.1007%2Fs10620-016-4403-z.

[6] Bouziat, R, Hinterleitner, R. & Brown, J., et. al. (2017, April 7). Reovirus Infection Triggers Inflammatory Responses to Dietary Antigens and Development of Celiac Disease. Science, 356(6333), 44-50. Doi: 10.1126/science.aah5298. Retrieved from http://science.sciencemag.org/content/356/6333/44.long.

[7] Kemppainen, K., Lynch, K. & Liu, E., et. al. (2017, May). Factors That Increase Risk of Celiac Disease Autoimmunity After a Gastrointestinal Infection in Early Life. Clinical Gastroenterology and Hepatology, 15(5), 694-702(e5). Doi: 10.1016/j.cgh.2016.10.033. Retrieved from http://www.cghjournal.org/article/S1542-3565(16)31043-6/fulltext.

[8] Stene, L., Honeyman, M. & Hoffenberg, E. & et. al. (2006, October). Rotavirus Infection Frequency and Risk of Celiac Disease Autoimmunity in Early Childhood: A Longitudinal Study. The American Journal of Gastroenterology, 101(10), 2333-2340. Doi: 10.1111/j.1572-0241.2005.00741.x. Retrieved from https://www.nature.com/articles/ajg2006431.

[9] Tjenberg, A. & Ludvigsson, J. (2014, July). Children with Celiac Disease are More Likely to Have Attended Hospital for Prior Respiratory Virus Infection. Digestive Diseases and Sciences, 59(7), 1502-1508. Doi: 10.1007/is10620-014-3046-1. Retrieved from https://link.springer.com/article/10.1007%2Fs10620-014-3046-1.

[10] Celiac Disease. (n.d.). The Free Dictionary by Farlex (Medical Dictionary). Retrieved from https://medical-dictionary.thefreedictionary.com/celiac+disease.

[11] Celiac Disease Symptoms List. (n.d.). Beyond Celiac. Retrieved from https://www.beyondceliac.org/celiac-disease/symptoms/.

[12] Celiac Disease Symptoms. (n.d.). Celiac Disease Foundation®. Retrieved from https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms/.

[13] Celiac Disease Symptoms List. (n.d.). Beyond Celiac. Retrieved from https://www.beyondceliac.org/celiac-disease/symptoms/.

[14] Rubio-Tapia, A., Hill, I., Kelly, C., et. al. (2013, May). American College of Gastroenterology Clinical Guideline: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 108(5), 656-677. Doi: 10.1038/ajg.2013.79. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706994/.

[15] Volta. U., Vincentini, O., Silano, M., et. al. (2011, May-June). Papillary Cancer of Thyroid in Celiac Disease. Journal of Clinical Gastroenterology, 45(5), e-44-46. Doi: 10.1097/MCG.0b013e3181ea11cb. Retrieved from https://insights.ovid.com/pubmed?pmid=20697293.

[16] Rubio-Tapia, A., Hill, I., Kelly, C., et. al. (2013, May). American College of Gastroenterology Clinical Guideline: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 108(5), 656-677. Doi: 10.1038/ajg.2013.79. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706994/.

[17] Rubio-Tapia, A., Hill, I., Kelly, C., et. al. (2013, May). American College of Gastroenterology Clinical Guideline: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 108(5), 656-677. Doi: 10.1038/ajg.2013.79. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706994/.

[18] Laine, O., Pitkanen, K., Lindfors, K., et. al. (2017, December 2). Elevated Serum Antiphospholipid Antibodies in Adults with Celiac Disease. Digestive and Liver Disease, S1590-8658(17)31314-2. Doi: 10.1016.j.dld.2017.11.018. Retrieved from http://www.dldjournalonline.com/article/S1590-8658(17)31314-2/fulltext.

[19] Ciaccio, E., Lewis, S, Biviano, A., et. al. (2017, August 25). Cardiovascular Involvement in Celiac Disease. World Journal of Cardiology, 9(8), 652-666. Doi: 10.4330/wjc.v9.i8.652. Retrieved from https://www.wjgnet.com/1949-8462/full/v9/i8/652.htm.

[20] Kurien, M., Ludvigsson, J., Sanders, D., et. al. (2018, January 5). Persistent Mucosal Damage and Risk of Epilepsy in People with Celiac Disease. European Journal of Neurology. Doi: 10.111/ene.13564. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29316034.

[21] Pennisi, M., Bramanti, A., Cantone, M., et. al. (2017, September 5). Neurophysiology of the “Celiac Brain”: Disentangling Gut-Brain Connections. Frontiers in Neuroscience, 11, 498. Doi: 10.3389/fnins.2017.00498. Retrieved from https://www.frontiersin.org/articles/10.3389/fnins.2017.00498/full.

[22] Sadr-Azodi, O., Sanders, D., Murray, J., et. al. (2012, October). Patients with Celiac Disease Have an Increased Risk for Pancreatitis. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, 10(10), 1136-1142(e3). Doi: 10.1016/j.cgh.2012.06.023. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29243228.

[23] Low-Beer, T., Heaton, S., Heaton, K., et. al. (1971, May 15). Gallbladder Inertia and Sluggish Enterohepatic Circulation of Bile-Salts in Celiac Disease. The Lancet, 297(7707), 991-994. Doi: 10.1016/s0140-6736(71)91387-0. Retrieved from https://www.sciencedirect.com/science/article/pii/S0140673671913870?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y.

[24] Mounajjed, T., Oxentenko, A. & Shmidt, T. (2011, July 1). The Liver in Celiac Dissease: Clinical Manifestations, Histologic Features, and Response to Gluten-Free Diet in 30 Patients. American Journal of Clinical Pathology, 136(1), 128-137. Doi: 10.1309/AJCPDOMY5RI5TPMN. Retrieved from https://academic.oup.com/ajcp/article/136/1/128/1766682.

[25] DiSabatino, A., Rosado, M., Cazzola, P., et. al. (2006). Splenic Hypofunction and the Spectrum of Autoimmune and Malignant Complications in Celiac Disease. Clinical Gastroenterology and Hepatology, 4, 179-186. Retrieved from http://www.cghjournal.org/article/S1542-3565(05)00982-1/pdf.

[26] Picca, A., Riezzo, G., Lezza, A., et. al. (2018, February). Mitochondria and Redox Balance in Coeliac Disease: A Case-Control Study. European Journal of Clinical Investigation, 48(2). Doi: 10.111/eci.12877. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29243228.

[27] Lauret, E. & Rodrigo, L. (2013). Celiac Disease and Autoimmune-Associated Conditions. BioMed Research International. 127589. Doi: 10.1155/2013/127589. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741914/.

[28] Celiac Disease. (n.d.). The Free Dictionary by Farlex (Medical Dictionary). Retrieved from https://medical-dictionary.thefreedictionary.com/celiac+disease.

[29] Celiac Disease: Who is at Risk? (n.d.). Beyond Celiac. Retrieved from https://www.beyondceliac.org/celiac-disease/risk-factors/.

[30] What is Celiac Disease? (n.d.). Beyond Celiac. Retrieved from https://www.beyondceliac.org/celiac-disease/what-is-celiac-disease/.

Comments
No. 1-2
Dr. Abby Campbell
Dr. Abby Campbell

Editor

I was surprised too, Lynne, until I started researching. With GMO crops continuing and taking over, I think we'll see a lot more gluten intolerant and Celiac disease. It's unfortunate.

Lrleblanc
Lrleblanc

Great article. I was unaware that a virus could cause celiac disease. My Mother in law is very intolerant to gluten. The drs. said we know she's intolerant. It's more than likely she's celiac. I am intolerant to gluten, but I don't feel I have celiacs

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