2.  An autoimmune disease where the protein gluten damages the villi in the small intestine causing malabsorption.  Celiac Disease is a lifelong condition.  Celiac Disease is also called celiac sprue, nontropical sprue, and gluten sensitivity enteropathy

3. Protein found in barley, rye, and wheat (includes spelt, kamut, and triticale)

4.  Immune system overreacts to gluten  Inflammation of mucosa in small intestine  Unknown cause, still being researched

5. Classic Symptoms  Abdominal distention/Bloating  Diarrhea  Stomach cramps  Gas  Constipation  Fatty stools

6.  Fatigue  Joint pain  Bone loss  Depression  Weight loss  Neuropathy  Skin rash  Mouth ulcers  Missed menstrual cycles  Infertility Less Obvious Symptoms

7.  Diarrhea or constipation (or both)  Failure-to-thrive  Stunted growth  Poor appetite or food aversion  Vomiting  Abdominal distention or bloating  Fatigue and irritability  Weight loss  Iron deficiency anemia  Behavior changes  Enamel defects of permanent teeth  Delayed puberty photo courtesy of Columbia University

8.  1 in 133 people are diagnosed with Celiac Disease  97% of people with Celiac Disease are not diagnosed!  Prevalence of Celiac Disease has increased in the past 50 years  Can be misdiagnosed as IBS, Crohn’s, Inflammatory Bowel Disease, parasitic infection, or other bowel disorder

9. Those diagnosed with:  Type 1 Diabetes  Autoimmune Thyroid condition  Rheumatoid Arthritis  Sjögren’s Syndrome  Addison’s disease  Down syndrome  Microscopic colitis  Autoimmune liver disease or hepatitis

10.  Endoscopy with Intestinal Biopsy  Specific antibody blood tests  Capsule Endoscopy (Camera Pill) – least common

11. Endoscopy and Biopsy Normal Celiac American Academy of Family Physicians www.aafp.org

12.  Elevated anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA) via blood test  Damaged villi (villous atrophy) via biopsy  Celiac Disease can be diagnosed at any age  The longer Celiac Disease goes undiagnosed, risk increases for complications

13.  Deficiencies of Iron, Folic Acid, B-12, calcium, and fat soluble vitamins  Lactose intolerance  Increased risk of GI cancers  Nervous system disorders  Pancreatic insufficiency  Bone loss

14.  No cure  Strict adherence to Gluten-Free(GF) Diet for life  If nutrient deficiencies exist, vitamin supplements will be needed  In severe cases, anti-inflammatory drugs may be needed to combat intestinal inflammation  New celiac patients should consult with a dietitian about a GF diet plan

15. Strict Avoidance of all products containing wheat, including wheat bran, wheat germ, semolina, durum, enriched flour, and farina, rye, and barley, including barley malt and malt While oats are technically gluten- free, they are commonly contaminated with gluten unless tested and labeled as gluten-free oats

16. Special care must be taken to avoid gluten in soups, seasonings, sauces, snack foods, processed meats, condiments, and beverages. Some restaurant chains have GF menus available.

17.  With strict adherence to GF Diet, intestinal damage can be healed  Intestinal healing takes 3 to 6 months in children  Healing will take years in adults  If improvement is not seen, diet should be investigated for hidden sources of gluten  Celiac disease is genetic  Long-term follow up is recommended

18. (2008). Celiac disease (NIH Publication No. 08–4269). Retrieved from National Digestive Diseases Information Clearinghouse website: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac http://digestive.niddk.nih.gov/ddiseases/pubs/celiac (2011). Celiac disease. Retrieved from Mayo Foundation for Medical Education and Research website: http://www.mayoclinic.com/health/celiac- disease/DS00319 http://www.mayoclinic.com/health/celiac- disease/DS00319 Celiac Disease Foundation. (2010). Are You the One? [brochure]. Retrieved from http://www.celiac.org/images/stories/PDF/are-you- the-one.pdf

19. Celiac Disease Foundation. (2010). Is Your Child the One? [brochure]. Retrieved from http://www.celiac.org/images/stories/PDF/is-your- child-the-one.pdf Presutti, R. J. (2007). Celiac disease. American Family Physician, 76 (12), 1795-1802. Retrieved from http://www.aafp.org/afp/2007/1215/p1795.html