Celiac Disease

Myths About Celiac Disease

 Celiac disease is a disease of children.
No doubt that celiac disease is commonly diagnosed in children but nowadays more cases are being diagnosed in adult age group.

 Celiac disease patients are emaciated, underweight and undernourished.
It is well known that the disease can present without features of malabsorption and patients may even be obese.

 Celiac disease always has history of diarrhea.
Diarrhea is the commonest presentation in developing countries but extraintestinal presentation of celiac disease is well known. Diarrhea when present may be episodic and may not be the presenting feature. Diarrhea may be totally absent and other presentations like anemia, osteoporosis, infertility etc. may be the only presenting feature.

 Celiac Disease is an allergic disease.
It is not an allergic disorder (IgE mediated). The intestinal damage occurs due to undigested wheat proteins rather than hypersensitivity reaction.

 Blood tests (serology) are sufficient for diagnosis of celiac disease
No. Duodenal biopsy should always be done before starting gluten free diet. The diagnosis should never be based only on serology as anti tTG may be high in others diseases like inflammatory bowel disease and chronic liver disease. In addition, serology may be negative in IgA deficient persons, mild disease or children less than 2-3 years.

 Wheat should be allowed during pregnancy otherwise newborn is likely to acquire celiac disease.
Genetics play a role but mother’s wheat intake does not influence the development of disease in newborn.

 Celiac disease can be outgrown.
Celiac disease requires a lifelong adherence to a gluten free diet to avoid complications. A celiac may become asymptomatic after a period of time on a gluten free diet but it does not mean one has outgrown it. It is just that the disease has become silent.

 A little bit of gluten every now and then will not hurt.
There is evidence that ingesting as small as 30 milligrams of gluten will cause damage to the intestine. Hence, intermittent ingestion of wheat can be harmful. At times celiac crisis can occur.

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