Celiac disease is a permanent autoimmune disorder where gluten intake results in damage to the intestinal lining. Villi – the finger like projections in the small intestine – responsible for absorption of nutrients get damaged resulting in nutritional deficiencies and many disease conditions.
The prevalence rate of celiac disease (including in India) is understood to be 1% globally with some variations across countries. Originally considered to be an Irish/European or Western disease, cases have been reported now from all parts of the world, Japan and South-East Asia being the only probable exceptions.
In India, celiac disease is suspected to be more prevalent in the North Indian population where wheat is primarily grown and forms the staple cereal. These states would include Punjab, Haryana, Delhi, Uttar Pradesh, Maharashtra, Rajasthan, Bihar, Uttaranchal, Madhya Pradesh and Gujarat.
So far, it was considered non-existent in South India but there is now evidence that it is being diagnosed in the native population of South India too though it is rarer than in the North.
Studies show that the prevalence of celiac disease has been doubling every 20 years. It is not clear why there has been an increase in the number of cases but the reasons could be many – an overall increase in the consumption of wheat, usage of the new strain of wheat which is considered more antigenic, increased use of antibiotics etc.
The diagnosis rate of celiac disease though is extremely low presently, only about 5%. That would mean out of 100 people affected with celiac disease, 95 are not aware of this condition! This has therefore been popularly depicted in the form of an iceberg where the visible part i.e. the number of diagnosed cases is miniscule (3-5%) whereas most of the cases are submerged, i.e., not yet diagnosed.
Three factors have been identified to be the prerequisites for celiac disease to develop: A gene, consumption of gluten and a trigger
All three factors have to be present for celiac disease to develop. The trigger can get activated at any age. Hence, celiac disease can develop at any age, from infancy to even 90 years.
Celiac disease is a multisystem multi-organ disorder impacting people differently. There are more than 200 signs and symptoms which have so far been associated with celiac disease.
Children more often exhibit the classical symptoms (mostly gastrointestinal) whereas in adults, the symptoms are mostly atypical or extra-intestinal. Non-bloody diarrhea, weight loss and iron deficiency anemia are the most common symptoms in adults.
Onset of symptoms can happen at any age. In India, most of the diagnosed cases are children but in countries where this disease was established 3-4 decades ago, about 20% or more of newly diagnosed cases are adults. Thus, the notion that this is a childhood disease, no longer holds true.
The understanding of symptoms is evolving with time, e.g., a large number of individuals with celiac disease are now considered to be asymptomatic – i.e. exhibit no symptoms but may still have high tTG values and even intestinal damage; celiac disease was never considered in an obese individual earlier but about 5-20% of all patients with celiac disease are now reported to be obese.
The list of symptoms are
The classical symptoms are gastrointestinal. These were so far considered as the typical presentation of celiac disease.
These are mostly extra-intestinal such as:
Unlike what was believed earlier, about one-third of all new patients present with atypical symptoms today.
Some individuals are more susceptible to developing celiac disease than others.
The diagnosis of celiac disease is based upon the following:
Source: Celiac India
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