Celiac Disease and Gluten Sensitivity: Heeding the Warning Signs and Avoiding Misdiagnosis
Some individuals endure years of misdiagnosis before discovering that the reason for their ill health is gluten, the protein found in certain grains like wheat, barley, and rye. Some of these individuals discover that they have Celiac Disease (CD), while others test negative for CD and instead suffer from Gluten Sensitivity (GS). Because the road to a proper diagnosis of either of these conditions is often a long one, it may be helpful to differentiate between the two and to discuss the common symptom profile of each one. Highlighting common misdiagnoses and revealing the current medical tests available may also be beneficial to those seeking answers to their health questions.
Celiac Disease (CD) is an autoimmune disorder in which the consumption of gluten elicits an immune response resulting in inflammation of the small intestine, and subsequently to mal-absorption of vital nutrients. As a result, CD can affect several body systems, such as the blood and skin, as well as the gastrointestinal (GI), endocrine, and nervous systems. Maintaining a gluten-free diet is the only treatment for CD.
Another condition requiring a gluten-free diet is Gluten Sensitivity (GS), also referred to as gluten intolerance. In individuals with GS, consuming gluten does not lead to intestinal damage; however, due to the negative symptoms experienced by these individuals, those with GS must also follow a gluten-free diet.
While common GI symptoms like bloating, excessive gas, diarrhea and/or constipation are considered to be hallmark symptoms of CD, there are an astonishing 300 symptoms associated with the disorder, with more common symptoms of CD reported as non-GI manifestations resulting from the negative immune response and/or a lack of proper nutrient absorption. The aforementioned GI symptoms are considered more typical of GS than CD.
Due to such varied symptoms as anemia, skin rash, oral lesions, inability to gain or lose weight, tingling or numbness in the extremities, fatigue, joint pain, and depression, it is understandable that CD or GS could be misdiagnosed, leaving an individual to suffer needlessly. Some common misdiagnoses are Irritable Bowel Syndrome (IBS) and related disorders like Crohn's Disease and Ulcerative Colitis, Diabetic Gastroparesis, and Diabetic diarrhea, due to the GI manifestations of these conditions. Common non-GI related misdiagnoses are Fibromyalgia, depression, Chronic Fatigue Syndrome, and a variety of nutrient deficiencies.
If you have any of the symptoms mentioned here and you believe you may have CD or GS, one option is to compile a list of your symptoms, schedule an appointment with your health care provider, and take that list with you to your appointment. Share your symptoms checklist and any other concerns with your doctor. If he or she believes you may have CD or GS based on what you describe, they may order serological testing, sometimes referred to as a Complete Celiac Blood Panel, to assess various antibody levels in your blood. Tests such as these are demonstrated to be an effective way to avoid potential misdiagnosis (Kumar et al, 2002) as well as a way to differentiate between CD and GS.
If immunologic assays reveal a positive result, your physician will likely order the test that is said to be the only definitive diagnostic for CD, the endoscopy and biopsy. In endoscopy, a very small camera attached to a thin flexible tube is inserted into the digestive tract via the mouth so that the physician can view the lining of the small intestine. The harsh effects of gluten in the gut of someone with CD are easily visible via endoscopy (this is not found in those with GS). A biopsy (small tissue sample) may be performed so that the villi (fingerlike projections lining the small intestine) may be more closely examined. These projections appear flattened and atrophied in those with CD. While none of these diagnostics is to be taken on its own to be definitive, they are very useful when taken together to aid in diagnosis.
Although CD and GS are not the same, they are both serious conditions with similar symptom profiles and are commonly misdiagnosed. Talking to your doctor and having the appropriate medical tests for these conditions is imperative to proper diagnosis and improved health.