Celiac Disease: Irritable Bowel Syndrome Explained
Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a serious genetic autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. This article will delve into the intricate details of this condition, its relationship with irritable bowel syndrome (IBS), and the various aspects surrounding these health issues.
Two and one-half million Americans are undiagnosed and are at risk for long-term health complications, such as the development of other autoimmune disorders like Type I diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers.
Understanding Celiac Disease
Celiac disease is a chronic digestive disorder resulting from an immune reaction to gliadin, a gluten protein found in wheat, barley, rye, and sometimes oats. It involves inflammation and destruction of the inner lining of the small intestine and can lead to the malabsorption of minerals and nutrients.
Individuals with celiac disease might have symptoms that include diarrhea, abdominal pain, bloating, fatigue, and anemia. However, some people with the disease may not have any symptoms. The only treatment for celiac disease is a strict gluten-free diet for life.
Causes of Celiac Disease
The exact cause of celiac disease is unknown, but it's often inherited. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease. Celiac disease is also more common among people with other genetic disorders including Down syndrome and Turner syndrome, a condition that affects girls' development.
Environmental factors play a key role in triggering celiac disease in infancy, childhood or later in life. A growing body of evidence shows that changes in the gastrointestinal microbiota caused by infections, surgery, or changes in the diet might be additional contributing factors.
Diagnosis of Celiac Disease
Diagnosing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been underdiagnosed or misdiagnosed.
As it stands today, blood tests are the first step in diagnosing celiac disease. Doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results suggest celiac disease, your doctor will recommend a biopsy of your small intestine to confirm the diagnosis.
Understanding Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.
Only a small number of people with IBS have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and counseling. IBS does not cause changes in bowel tissue or increase your risk of colorectal cancer.
Causes of IBS
The precise cause of IBS isn't known. Factors that appear to play a role include muscle contractions in the intestine, abnormalities in the nerves in your digestive system, inflammation in the intestines, severe infection, and changes in bacteria in the gut.
Some people can have IBS symptoms for years before they seek medical help. Most people have mild symptoms, but chronic and severe symptoms can interfere with work, sleep, and everyday life. The symptoms can often be managed by controlling diet, lifestyle, and stress.
Diagnosis of IBS
There's no test to definitively diagnose IBS. Your doctor is likely to start with a complete medical history, physical exam and tests to rule out other conditions. If you have IBS with diarrhea, you likely will be tested for gluten intolerance (celiac disease).
After other conditions have been ruled out, your doctor is likely to use one of these sets of diagnostic criteria for IBS: Rome criteria and Manning criteria. These criteria include certain signs and symptoms that, if present, suggest a diagnosis of IBS.
Link Between Celiac Disease and IBS
There is a well-established link between irritable bowel syndrome (IBS) and celiac disease. This is largely due to the fact that both conditions share common symptoms, including diarrhea, abdominal cramping, and bloating. In fact, many individuals with celiac disease are initially misdiagnosed with IBS.
Research has shown that a significant number of people with IBS also have celiac disease. A study published in the American Journal of Gastroenterology found that individuals with IBS were four times more likely to have celiac disease than the general population.
Importance of Proper Diagnosis
Given the overlap in symptoms between IBS and celiac disease, it is crucial that individuals experiencing symptoms receive a proper diagnosis. This is particularly important for those with celiac disease, as continuing to consume gluten can lead to serious health complications, including nutrient deficiencies, osteoporosis, infertility, neurological disorders, and even certain types of cancer.
Unfortunately, many individuals with celiac disease remain undiagnosed and continue to suffer from ongoing symptoms. This is often due to a lack of awareness about the condition, both among the general public and within the medical community. Therefore, increasing awareness and understanding of celiac disease is crucial in improving diagnosis rates and ultimately, patient outcomes.
Management of Both Conditions
Management of both IBS and celiac disease primarily involves dietary modifications. For those with celiac disease, this means adhering to a strict gluten-free diet. This involves eliminating all foods that contain wheat, barley, and rye. Many individuals with celiac disease also find that they are sensitive to oats.
For those with IBS, dietary modifications can be more complex and individualized. Some individuals find that they are sensitive to a group of carbohydrates known as FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). These are found in a wide range of foods, including certain fruits and vegetables, dairy products, and wheat and rye. Therefore, a low-FODMAP diet may be recommended.
Conclusion
In conclusion, celiac disease and irritable bowel syndrome are two distinct conditions that share common symptoms. It is important for individuals experiencing symptoms such as diarrhea, abdominal pain, and bloating to seek medical advice, as these could be indicative of either condition.
With the right diagnosis and management, individuals with either celiac disease or IBS can lead healthy, symptom-free lives. This involves understanding the nature of these conditions, making necessary dietary modifications, and working closely with healthcare providers to manage symptoms and monitor the condition.
