Celiac disease, an autoimmune condition, can develop at any point in a person’s life, including during adulthood. This condition is triggered by the consumption of gluten, a protein found in wheat, barley, and rye. When individuals with celiac disease ingest gluten, their immune system mistakenly attacks the lining of the small intestine. This immune response leads to damage that can hinder the absorption of nutrients.
Understanding Celiac Disease Onset
The development of celiac disease is not solely dependent on gluten consumption but also involves a genetic predisposition. Most individuals who develop celiac disease carry specific genes, primarily HLA-DQ2 or HLA-DQ8. While these genes are necessary for the condition to manifest, their presence alone is not sufficient, as many people with these genes never develop the disease.
Even with genetic susceptibility, celiac disease can remain dormant for many years before becoming active. Various environmental factors or significant physiological stressors can act as triggers, initiating the autoimmune response. Events such as surgery, a severe viral infection, pregnancy, or periods of intense emotional stress have been observed to precede the onset of symptoms in genetically predisposed individuals. External factors can activate this pre-existing genetic vulnerability, leading to clinical symptoms.
Recognizing Adult Symptoms
Symptoms of celiac disease in adults are often varied and differ from those commonly seen in children. While some adults may experience classic digestive issues, many present with non-digestive, or extraintestinal, symptoms that can be vague and easily overlooked. This broad spectrum of manifestations often leads to delays in diagnosis.
Common adult symptoms include:
Persistent fatigue, iron-deficiency anemia unresponsive to supplements, and unexplained joint pain.
A characteristic itchy skin rash known as dermatitis herpetiformis.
Neurological issues, such as peripheral neuropathy or “brain fog.”
Reproductive problems like infertility or recurrent miscarriages in women.
The Diagnostic Journey
Diagnosing celiac disease in adults involves a specific sequence of tests, and it is important that individuals continue to consume gluten throughout the diagnostic process. Discontinuing gluten before testing can lead to inaccurate results, making diagnosis more challenging. The initial step involves blood tests to screen for specific antibodies.
Key antibody tests include tissue transglutaminase IgA (tTG-IgA) and endomysial antibody IgA (EMA). If these blood tests indicate the presence of celiac disease antibodies, a small intestinal biopsy is then recommended to confirm the diagnosis. During this procedure, tissue samples are taken from the small intestine and examined under a microscope for characteristic damage. Genetic testing for HLA-DQ2/DQ8 can be used to rule out celiac disease if negative, but a positive result does not confirm the diagnosis on its own.
Managing Adult-Onset Celiac Disease
Once diagnosed, the most effective treatment for adult-onset celiac disease is a strict, lifelong adherence to a gluten-free diet. This involves eliminating all foods containing wheat, barley, and rye. Avoiding cross-contamination, where gluten-free foods come into contact with gluten-containing items, is also an important part of managing the condition.
Adopting a gluten-free diet allows the damaged small intestine to heal, leading to a resolution of symptoms and improved nutrient absorption. Individuals often benefit from nutritional counseling to understand how to maintain a balanced gluten-free diet and identify hidden sources of gluten. Regular follow-ups with a healthcare provider are important to monitor healing, address any lingering symptoms, and screen for potential nutritional deficiencies.