A man suffering from liver cirrhosis, a girl with delayed puberty and a woman struggling with fertility issues may have one disease in common that is triggering all these problems. It is hard to believe but celiac disease, a digestive and autoimmune disorder, can make a person susceptible to some major health problems.
Celiac India, a non-profit venture started by gastroenterologist Dr Pankaj Vohra, has brought to people’s notice some interesting facts about the disease which is fast becoming a health threat to the people in India. Around 1 per cent of the world’s population suffers from it, which means more than a crore of people in India may be suffering from it. It is more prevalent than AIDS as 0.7 per cent of the world population are at the risk of developing it. However, celiac disease awareness is pretty low in India given the fact that it was considered to be a disease of the West.
This autoimmune disorder results in damage to the lining of the small intestine when foods with gluten are eaten. “Celiac disease is both an allergy and a disease. Allergy to dietary gluten in individuals with a genetic predisposition triggers an immune disorder that damages the intestinal lining in small intestine,” Dr Avnish Seth, director of gastroenterology and hepatobiliary sciences in Fortis Memorial Research Institute, Delhi.
Gluten is a form of protein found in some grains like wheat, barley and rye. When people with celiac disease eat foods containing gluten, their immune system forms antibodies to gluten which then attack the intestinal lining. This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron and folate. “Absolute gluten-free diet is a must for life for preventing damage and development of other complications including other autoimmune disorders and malignancy. I think it is important for people to understand that even intakes of minute amounts of gluten like - 1/10,000 piece of a bread will result in damage to the intestine. This must be understood by the patient, the immediate family and the providers of gluten-free food,” says Dr Vohra. With his years of experience as a pediatric gastroenterologist, he has diagnosed and managed about 1,000 children with celiac disease in the past 15 years.
However, unlike many diseases it is difficult to pin down a few symptoms and diagnose. Besides the classical gastrointestinal symptoms like constipation, abdominal pain, chronic diarrhea, a patient may suffer from other symptoms like skin rashes called dermatitis herpetiformis, retarded growth, infertility, osteoporosis, delayed puberty, alopecia etc. “Celiac disease is tricky to diagnose because the clinical manifestations are varied. The classic description is of a child with chronic diarrhea, stunted growth and anaemia. However, many of the times the clinical manifestations are atypical and may present in adulthood. Instead of diarrhoea , the patients may present with, fatigue, weight loss, anemia, low Vitamin D with weak bones, deranged liver function tests, constipation, neurological disorders etc.,” says Dr Seth.
Even though awareness about celiac disease has increased over the last few years, much more needs to be done. The various presentations of celiac disease have to be kept in mind by all members of the society so that there is no delay in diagnosis. “The general practitioners should carry out screening blood tests at the slightest suspicion and refer early to tertiary care centres for evaluation, including intestinal biopsy. At the same time the message has to go across that one can live a normal life on gluten-free diet. In fact, one of the Wimbledon champions, Novak Djokovic, is on gluten-free diet. The availability and variety of these foods in the country can do with improvement. Celiac Society of India is doing good work in increasing awareness and in patient support activities,” says Dr Seth