A new study originating from Britain has specified that the rate of diagnosed cases of celiac disease, (CD), has increased fourfold; but that three quarters of people with celiac disease remain undiagnosed, suggesting that the condition may be a hidden epidemic.
Celiac disease is an autoimmune disease caused by intolerance to gluten; untreated it may lead to infertility, osteoporosis and small bowel cancer.
The symptoms of celiac disease affect the gut including the entire body and range from mild to severe. Symptoms can include ongoing gut problems such as bloating, abdominal pain, nausea, constipation, diarrhea, and wind, and other common symptoms include extreme tiredness, anemia, headaches and mouth ulcers, weight loss (but not in all cases), skin problems, depression, and joint or bone pain. It is a multifactorial disease associated with numerous nutritional deficiencies as well as reproductive issues and increased risk to thyroid disease, kidney failure and cancer.
The research data was published in the American Journal of Gastroenterology and the number of people diagnosed during the study period was diagnosed using the diagnostic codes for celiac disease recorded in the Clinical Practice Research Datalink (1990-2011).
Sarah Sleet, Chief Executive of Celiac UK said: “This latest research shows that nearly a quarter of people with celiac disease have now been diagnosed and gives an up to date picture of the diagnosis levels across the UK. Of course, increasing numbers with a diagnosis is good news and will inevitably mean that there will be an increased demand for gluten-free products in supermarkets. But the three quarters undiagnosed is around 500,000 people — a shocking statistic that needs urgent action.”
There is a large volume of research that links celiac disease to disturbance in the gut bacteria caused by environmental factors which could include pesticides and herbicides.
In fact, rod shaped bacteria adhering to the small intestinal mucosa were frequently seen in patients with CD during the “Swedish CD epidemic” and bacterial candidates could later be isolated from patients born during the epidemic suggesting long-lasting changes in the gut microbiota.
Interleukin-17A (IL-17A) plays a role in both inflammation and anti-bacterial responses. In active CD IL-17A was produced by both CD8+ T cells (Tc17) and CD4+ T cells (Th17), with intraepithelial Tc17 cells being the dominant producers. Gluten peptides as well as CD associated bacteria induced IL-17A responses in ex vivo challenged biopsies from patients with inactive CD. The IL-17A response was suppressed in patients born during the epidemic when a mixture of CD associated bacteria was added to gluten, while the reverse was the case in patients born after the epidemic. Under these conditions Th17 cells were the dominant producers. Thus Tc17 and Th17 responses to gluten and bacteria seem to pave the way for the chronic disease with interferon-γ-production by intraepithelial Tc1 cells and lamina propria Th1 cells. The CD associated bacteria and the dysbiosis they might cause in the resident microbiota may be a risk factor for CD either by directly influencing the immune responses in the mucosa or by enhancing inflammatory responses to gluten.
Veronika Sjöberg, Olof Sandström, Maria Hedberg, Sten Hammarström, Olle Hernell, Marie-Louise Hammarström. Intestinal T-cell Responses in Celiac Disease – Impact of Celiac Disease Associated Bacteria PLoS One. 2013; 8(1):
Joe West, Kate M Fleming, Laila J Tata, Timothy R Card, Colin J Crooks. Incidence and Prevalence of Celiac Disease and Dermatitis Herpetiformis in the UK Over Two Decades: Population-Based Study. The American Journal of Gastroenterology, 2014; 109 (5): 757 DOI: 10.1038/ajg.2014.55