Symptoms of Gluten Disease:
Symptoms of gluten related disorder may be difficult to separate from other gastrointestinal illnesses, and include diarrhea, constipation, weight loss, weight gain, abdominal bloating, malodorous stool, and abdominal pain. Gluten disease may also cause extraintestinal health problems such as bone demineralization, osteoporosis, joint pains, weight gain, weight loss, elevated liver function tests, enamel defects, apthous stomatitis, lower birth weights, poor childhood weight gain, hypocalcemia, fatigue, weakness, dry skin, blistering rash, eczema, iron deficiency anemia, infertility, microscopic colitis, pancreatic exocrine dysfunction, depression, neuropathy or numbness of the extremities, cerebellar ataxia, epilepsy, dementia, and headaches. The tongue is also commonly affected with soreness, burning, redness or atrophy. Infrequent diarrhea plus tongue symptoms have often led to a diagnosis of celiac disease (3).
The Difference Between Celiac Disease and Gluten Sensitivity
According to Ludvigsson JF, et al (2) classic celiac disease or celiac sprue is characterized specifically as symptoms of malabsorption, failure of growth, diarrhea, poor fat absorption and/or weight loss. The authors recommended that gluten sensitivity be renamed as non-celiac gluten sensitivity. Those with non-celiac gluten sensitivity may have many similar but more mild symptoms than celiac disease. These individuals have an immune response to gluten, but do not have the elevation in transglutaminase (TTG) antibodies or the pathologic changes of celiac disease present within the bowel walls on a biopsy. There is no current standard diagnostic test for non-celiac gluten sensitivity, nor is there a method available to measure a immune response.
Gluten Related Disorder Screening:
According to Rubio-Tapia A et al (4) patients should be evaluated for celiac disease if there are:
- Signs or symptoms of malabsorption
- Lab testing with signs of malabsorption
- Signs or symptoms with a 1st degree relative who has gluten disease
- Unknown increase in liver function tests
- Diabetes mellitus type 1 with signs or symptoms of malabsorption
Diagnosis of Gluten Disease and Gluten Related Disorders
Proper diagnosis may be complicated and is best accomplished by the primary care physician and gastroenterologist. Celiac disease should not be self-diagnosed by patients since the condition has non-specific symptoms which require to be distinguished from other gastrointestinal conditions. If a patient is believed to have symptoms of celiac disease, testing should ideally be done while on a diet containing gluten.
