What's the Difference Between Celiac Disease and Gluten Sensitivity

Celiac Disease and Gluten Sensitivity: An Interview With Medical Experts Posted: 09/13/2012 8:11 am http://www.huffingtonpost.com/sz-berg/celiac-disease_b_1770781.html In honor of National Celiac Disease Awareness Day and to kick off my William Edwards book series, a new series of novels for kids ages 8-12 years in which the main character, William Edwards, has celiac and a food allergy, I'm writing a series of posts about celiac, gluten sensitivity and food allergies, including interviews with actress Jennifer Esposito (Crash) , musician Allie Moss (Corner), and Disney's Kenton Duty. What follows are email interviews with both Alessio Fasano, M.D., medical director of the University of Maryland Center for Celiac Research, and Daniel Leffler, M.D., director of clinical research, The Celiac Center at BIDMC. Both are NFCA scientific/medical advisory board members. S.Z. Berg: What is the difference between gluten sensitivity and celiac disease? Is it a spectrum? Can you have gluten sensitivity and not have the gene for celiac? Dr. Alessio Fasano: Think of gluten ingestion on a spectrum. At one end, you have people with celiac disease. This autoimmune disorder triggered by gluten causes intestinal damage leading to malabsorption of nutrients, which results in a wide variety of symptoms and potential complications. It can affect the gastrointestinal system, the central nervous system, and other areas of the body. It can affect anyone at any age and is treatable through the implementation of a strict gluten-free diet for life. People with celiac disease can't tolerate one "crumb" of gluten in their diet. At the other end are the lucky folks who can consume all the pasta, bread and beer they want with no ill effects whatsoever. In the middle, we have this murky area of gluten reactions, including gluten sensitivity. This is where we are looking for answers about how to best diagnose and treat this recently-identified group of gluten-sensitive individuals. Although symptoms of gluten sensitivity (particularly gastrointestinal) are often similar to those of celiac disease, the overall clinical picture is less severe. Recent research at the University of Maryland Center for Celiac Research shows that gluten sensitivity is a different clinical entity. It doesn't seem to result in the intestinal inflammation that leads to a flattening of the villi of the small intestine that characterizes celiac disease. The development of tissue transglutaminase (tTG) autoantibodies, used to diagnose celiac disease, is not present in gluten sensitivity. A different immune mechanism, the innate immune response, comes into play in reactions of gluten sensitivity, as opposed to the long-term adaptive immune response that arises in celiac disease. We use the term gluten sensitivity when celiac disease, wheat allergy, and other clinically-overlapping diseases (Type 1 diabetes, inflammatory bowel diseases and Helicobacter pylori infection) have been ruled out. Symptoms in gluten sensitivity are triggered by gluten exposure and alleviated by gluten withdrawal. In gluten sensitivity, there is often a prevalence of extraintestinal instead of gastrointestinal symptoms, including behavioral changes, skin rash, bone or joint pain, muscle cramps, leg numbness, weight loss, "foggy mind," and fatigue. Typical gastrointestinal symptoms include abdominal bloating and gas. Typically, the diagnosis is made by exclusion, and an elimination diet and "open challenge" -- we carefully reintroduce foods with gluten -- are most often used to evaluate whether the patient's health improves with the elimination or reduction of gluten from the diet. Through clinical data from the Center for Celiac Research, we estimate that approximately six percent of the U.S. population, or 18 million people, suffers from gluten sensitivity. This group reacts with some of the same symptoms as people with celiac disease, but gluten-sensitive individuals typically test negative for celiac disease in diagnostic blood tests and show no signs of the damage to the small intestine that defines celiac disease. Contrary to celiac patients who almost invariably (the percentage is close to 100 percent) express the HLA DQ2 and/or DQ8 genes, only 50 percent of subjects with gluten sensitivity are positive for these genes (compared to approximately 35-40 percent of the general population). Dr. Daniel Leffler: Celiac disease is an immune-mediated disease triggered by gluten, which results in significant inflammation and damage to the small intestine as well as formation of antibodies, which can attack tissues in your body. Gluten sensitivity is a disorder where people have symptoms related to gluten exposure that may be indistinguishable from celiac disease but does not damage the intestine or result in abnormal antibody production. Whether gluten sensitivity is more related to celiac disease or irritable bowel syndrome is unclear, though most investigators currently favor the latter. One reason for this is that it is clear that you can have gluten sensitivity without the gene for celiac disease, while it is very rare for people with celiac disease not to carry these genes.