What are the risk factors and complications of celiac disease?

Who is at risk for coeliac (celiac) disease?

Coeliac disease is known to run in families. The University of Chicago Medical Centre noted that if a person has someone in their family with the condition (particularly a sibling or parent) then the person has a one in 22 chance of developing the disease.

Those who suffer from another autoimmune disease, as well as a certain genetic disorder, may also be more likely to develop celiac disease. The conditions that are associated with celiac disease include:

• Rheumatoid arthritis
• Type 1 diabetes
• Thyroid disease
• Sjogren’s syndrome
• Lactose intolerance
• Down syndrome
• Intestinal cancer
• Autoimmune liver disease
• Lupus
• Addison’s disease
• Intestinal lymphoma
• Turner syndrome

What are the complications of coeliac disease?

If celiac disease is left untreated, it can result in:

• Malnutrition – From the damage done to the small intestine, this results in the damaged villi not being able to absorb the nutrients needed for the body to function and grow properly.  This results in malnutrition which can lead to weight loss and anaemia. Malnutrition in children can affect their growth and development.
• Infertility and miscarriage – Reproductive issues can stem from the malabsorption of nutrients as a woman’s body is not healthy enough to fall pregnant or keep a baby healthy and nurtured naturally until full term. This is due to the lack of iron, zinc, folic acid and selenium, which are all nutrients needed to maintain a healthy pregnancy. Sticking to a gluten-free diet will significantly reduce a woman’s risk of infertility and miscarriage.
• Loss of bone density and calcium – These issues are also linked to the body not being able to absorb the nutrients needed. The malabsorption of vitamin D and calcium can result in the bones softening, which is also known as rickets or osteomalacia in children. In adults, the resulting loss of the bone density is known as osteoporosis.
• Cancer – Those who have celiac disease and do not stick to a strict gluten-free diet, may have a higher risk of developing a number of different kinds of cancer due to their body being weakened and intestinal damage. Kinds of cancer in these cases can include small bowel cancer and intestinal lymphoma.
• Lactose intolerance – Diarrhoea and abdominal pain are commonly experienced due to the small intestine being damaged. These symptoms tend to occur when a person who has celiac disease eats foods that contain lactose, namely dairy products. This is due to the fact that the small intestine is not healthy enough to process lactose. Once the small intestine has healed, the person may be able to have dairy products once again. It is sometimes the case, however, that some people will continue to suffer from lactose intolerance, regardless of their gluten-free diet.
• Neurological issues – In some cases of coeliac disease, the patient may develop a neurological issue such as seizures or peripheral neuropathy, this is a nerve condition that affects the hands and feet.

Children who have celiac disease may also suffer from a failure to thrive physically, weight loss, teeth defects, arthritis, epilepsy, anaemia and delayed puberty.

Nonresponsive celiac disease (NRCD)

About 20 to 30% of those with coeliac disease are not able to reduce their symptoms by following a gluten-free diet. This is a condition referred to as nonresponsive coeliac disease (NRCD). Basically, this means that some people with this type of coeliac disease do not respond well to a gluten-free diet.

NRCD can be a serious condition and should not be taken lightly. The most common cause of this condition is when patients fail to follow a diet that is completely gluten-free due to their lack of knowledge or their lack of commitment to the diet. The first step in treating this condition is to see a dietician and have an accurate diet plan drawn up.

People who suffer from NRCD may also suffer from additional conditions such as bacterial overgrowth in the small intestine, poor pancreatic function, IBS (irritable bowel syndrome), microscopic colitis or other intolerances to lactose or fructose, or these patients may suffer from refractory celiac disease. Refractory celiac disease is a condition where the small intestine does not heal, despite following a strict gluten-free diet, we explain this more below.

Refractory celiac disease

In some very rare cases, the damage done to the small intestine will not heal and this may lead to a substantial amount of malabsorption of nutrients, despite sticking to a gluten-free eating plan.

Those who continue to experience the symptoms and signs of celiac disease after a period of six to 12 months may be advised to undergo additional testing. Their doctor could suggest that they follow a treatment plan that includes the administration of steroids to reduce the inflammation of the intestine or medication to suppress the immune system response.