American Medical Association Family Medical Guide - American Medical Association [499]
Villi in celiac disease
Villi (left) are tiny fingerlike projections that line the inner wall of the small intestine and help break down and absorb nutrients from food. In people with some intestinal disorders such as celiac disease, the villi flatten out (right), reducing the body’s ability to absorb nutrients.
Celiac disease is most common in people of northern European descent. Screening for celiac disease is not done routinely in the United States. Because of the risk of complications and malnutrition that can develop if celiac disease goes untreated, first-degree family members (such as parents, siblings, and children) of people who have been diagnosed with celiac disease should be tested for the disease. Ten percent of first-degree relatives of an affected person also have celiac disease.
Symptoms
Gastrointestinal symptoms of celiac disease depend on the amount of gluten ingested. Symptoms may include a swollen abdomen, excess gas, abdominal pain, chronic diarrhea, or pale, foul-smelling stool. Other symptoms (of malnutrition) can include canker sores (see page 743), tooth discoloration, pain in the bones and joints, muscle cramps, tingling and numbness in the legs, rash (dermatitis; see page 1062), weight loss, or fatigue. In addition to the above symptoms, celiac disease can cause failure to thrive in infants and delayed growth in children. In women, celiac disease can cause missed menstrual periods (amenorrhea; see page 846) and bone loss leading to osteoporosis and fractures.
Diagnosis
If you have symptoms of celiac disease, your doctor will perform a physical examination and may order blood tests to determine the levels of antibodies (proteins the body has produced to defend itself against gluten). He or she will try to rule out cancer or a viral or bacterial infection by testing stool samples for blood, viruses, or bacteria. A diagnosis of celiac disease can be confirmed with a biopsy (in which samples of cells are taken from the intestine and examined under a microscope) to check for damage to the villi.
Treatment
The usual treatment for celiac disease is to eliminate all gluten-containing foods from the diet. Your doctor will advise you to avoid baked goods, cereals, pasta, and any other foods (or drinks such as beer, ale, vodka, gin, or whiskey) that contain wheat, barley, rye, or oats. Although oats may not cause symptoms in all people who have celiac disease, they should be avoided because gluten in oats can damage the villi without causing symptoms. Gluten can also be found in medications, mouthwashes, and some additives, preservatives, and stabilizers. Within a few days of following a gluten-free diet, most symptoms improve and the intestinal lining starts to heal. In rare cases, some people with celiac disease don’t respond to a gluten-free diet and may need to take corticosteroids or other medications to reduce inflammation. Some people have to be fed intravenously (through a vein) to get adequate nutrition.
Tumors of the Small Intestine
Like tumors elsewhere in the body, tumors of the small intestine can be malignant (cancerous) or benign (noncancerous). Most are benign (only 1 of 10 cases is malignant). Tumors of the small intestine may cause no symptoms and are often diagnosed by tests performed for another reason. In rare cases, they may be carcinoid tumors (see page 761).
Symptoms
Tumors in the small intestine can cause symptoms of anemia (see page 610) such as paleness, fatigue, or palpitations (heartbeats that you are aware of). You may have traces of blood in your stool or very dark, bloody stool. If a tumor is very large, it may cause abdominal pain and an intestinal obstruction (see page 759). If the cancer spreads to other