My doctor told me that I cannot tolerate gluten, but she never used the word celiac. Are gluten intolerance and celiac disease the same thing?

A.

Gluten-sensitive enteropathy (gluten intolerance) is another term for the condition known as celiac disease or celiac sprue. In this condition, the small intestine develops an allergic reaction to a certain protein called gluten, found in wheat, barley, rye and oats. When patients with celiac disease eat foods containing gluten, they usually develop abdominal bloating and diarrhea. Because the condition also impairs the ability of the intestine to absorb nutrients, vitamins and minerals, it can also lead to malnutrition, bleeding and osteoporosis.

It is not well understood why gluten causes problems in some people. The currently accepted theory is that gluten is recognized by certain cells in the intestine and leads to an inflammatory autoimmune response. However, this cycle only occurs in people who have a specific genetic makeup that will produce certain cells capable of recognizing the gluten. It is also thought that the sensitivity to gluten may be activated when a genetically predisposed person is exposed to an environmental trigger, such as an infection or stress. People of northern European descent appear to be at highest risk for the disorder. However, recent studies have found that celiac disease is much more common in the United States than many doctors had previously thought.

If celiac disease is suspected, the diagnosis is confirmed by removing a tissue sample from the small intestine and examining it under the microscope. In addition, tests have shown that certain types of antibodies are elevated in the bloodstream of patients suffering from celiac disease.

The standard treatment for celiac disease is to avoid all foods that contain gluten. This may seem easy, but, in reality, following such a strict diet can be very difficult because many foods, from bread to salad dressings, may contain gluten. In addition, some non-food products such as toothpaste and the glue on postage stamps may have gluten as an ingredient. It is important for every patient with gluten sensitivity to consult with a dietitian who is experienced in gluten-free diets.

That said, a small percentage of patients with celiac disease do not get better even when they avoid gluten. They are categorized as having refractory celiac sprue. In these cases, patients may require steroids or other immunosuppressive medications to control their disease. A few very rare cases of celiac disease do not respond to any therapy and can be complicated by intestinal tumors, such as lymphomas.

There is also an interesting association between celiac disease and dermatitis herpetiformis, a rare disease characterized by itchy nodules on the skin. Almost all people with dermatitis herpetiformis have or will develop celiac disease. Why these two diseases are associated with each other remains a mystery at this time.