Understanding complications of celiac disease can be quite tricky and for any parent, the thought of passing on a disease with so many variables to a child can be devastating. To help answer our reader questions about complications associated with celiac disease and the likelihood of the disorder being passed on to kids, we've called on Dr. Aline Charabaty, a celiac expert and the Director of the Center for Inflammatory Bowel Diseases at Georgetown University Hospital in Washington DC.
Enjoy this wonderful insight and if you think of more questions, submit them anytime to email@example.com. All of the questions you see answered below were submitted by readers just like you!Question 1: Celiac is related to many other autoimmune conditions. Does celiac cause the other conditions or do the other conditions cause the celiac disease?
Answer from Dr. Charabaty: Celiac disease is an auto-immune (AI) disorder and patients with celiac disease are at increased risk of developing other AI diseases, such as type I diabetes, rheumatoid arthritis and AI thyroid disease. Often, patients with any type of AI disease have a tendency to develop another AI disorder. So there is an association between celiac disease and other AI diseases, but it does not necessarily mean that one causes the other. At this point, there is no clear evidence that patients with celiac disease on a gluten-free diet are at decreased risk of developing other AI diseases.
Question 2: I was diagnosed with IBD but I'm still sick all the time. My doctor said he doesn't think I need to be tested for celiac disease, but everything I've read online seems like I should be tested. What can I tell my doctor to convince him to order the test?
Answer from Dr. Charabaty: Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases (IBD). Patients with IBD develop abdominal pain, diarrhea and blood in the stool. The diagnosis is typically made on colonoscopy with findings of inflammed ulcerated mucosa. I have seen in my practice several patients with both IBD and celiac disease. I have few patients who were diagnosed with both pathology concomitantly while being evaluated for gastrointestinal symptoms. On the other hand, I have seen patients whose IBD is well controlled with medical therapy, but who continue to experience abdominal pain and diarrhea; a portion of these patients had positive celiac serology and findings compatible with celiac disease on small bowel biopsies.In an article that was published in 2005, Yang et al. reported that the prevalence of ulcerative colitis and Crohn's disease was significantly higher among patients with celiac disease than in the general population (prevalence rate ratios of 3.6 and 8.5, respectively). In 5 out of 10 patients with both celiac disease and IBD, the diagnosis of celiac disease preceded that of IBD (by 7 months to 12 years).
I am including the reference to the article I am quoting. Yang A et al. (2005) Inflammatory bowel disease in patients with celiac disease. Inflammatory Bowel Disease Journal 11: 528-532
Question 3: My husband and I are trying to get pregnant. I have celiac disease and he doesn't. Is there any way we can prevent our future child from being a carrier of the gene or prevent them from developing celiac?
Answer from Dr. Charabaty: A child with one parent with celiac disease has a 5% risk of developing celiac disease. So beside inheriting a genetic predisposition from a parent, an environmental trigger must occur in order for the child to develop celiac disease. We have no means to prevent specific genes from passing from a parent to a child. One option is to test the child for HLA-DQ2 and HLA-DQ8, the 2 genotypes that have been associated with celiac disease. If your child is negative for these genes, it's unlikely he/she will develop celiac disease. However, if the child is positive for these genes, it does not necessarily means he/she will develop celiac disease (30% of the non celiac population is positive for these genes), but the risk is there. There is no evidence that a "prophylactic" gluten-free diet will prevent the development of celiac disease in people who have a genetic predisposition. However, pediatricians recommend delaying introducing solid food to 6 months of age for children born to families with food allergies, to decrease the risk of certain food allergies. Breastfeeding has been shown to be protective against the development of certain immune and allergic disorders in the children. There are currently ongoing studies looking at whether the age, the dose of gluten and the presence of simultaneous breastfeeding at the time of introduction of gluten are associated with the risk of celiac disease.
Question 4: My mother and I both have celiac disease and now my husband and I have three children ages 4, 9 and 12. I heard at a support group that all kids with celiac parents should be tested. At what age should we get them tested for celiac? Do they need to show symptoms or should I have them all tested now?
Answer from Dr. Charabaty: People who will develop celiac disease in their lifetime have a genetic predisposition to do so. Virtually all patients with celiac disease are positive for the HLA-DQ2 and/or HLA-DQ8 genes. At some point in life, patients will developed the antibodies associated with celiac disease and then will develop damage to their small bowel and symptoms of celiac disease. So one way to approach the issue, is to test the children for HLA-DQ2 and HLA-DQ8. If a child tests negative for these genes, it is unlikely he/she will develop celiac disease. If a child tests positive for these genes, then in the context of the family history of celiac disease, this child might be at risk of developing celiac disease. The next step would be to test for the celiac serology periodically or to perform the blood test only if symptoms develop. Serology testing can be done in children starting at 3 years of age. If the child has a positive serology, the diagnosis needs to be confirmed by small bowel biopsies. A gluten-free diet is recommended for children who have a positive celiac serology AND: 1-An abnormal small bowel biopsy and symptoms of celiac disease, OR 2-An abnormal small bowel biopsy even if there are no symptoms, OR 3-Dermatitis herpetiformis confirmed with a skin biopsy. Currently, there is no evidence that a gluten-free diet is of any benefit in children with a positive genotype and in children with a positive celiac serology but negative small bowel biopsies and no symptoms.