Q: Twelve years ago I started having bloating, gas and weight loss. My primary doctor ordered a colonoscopy, which came back normal. Then she kept telling me "When you get older these things happen." It wasn't until seven years (and several doctors) later that another doctor, a gastroenterologist, diagnosed me with celiac disease. How can I have gone for so long without a physician figuring out what was wrong with me?
- Finally Gluten-Free Elinor

A: I do not want to defend the first doctor, but your disease is not often thought about when stomach complaints are evaluated. We have discussed many abdominal complaints in this column, but I have not mentioned it even once.

Some estimate that nine out of 10 people with it are never diagnosed.

Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food.

The small intestine is the part of the digestive tube right after the stomach. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley.

Gluten may also be found in products we use every day, such as stamp and envelope adhesive, medicines and vitamins. When people with celiac disease eat foods or use products containing gluten, their immune (self-defense) system responds by damaging the small intestine. The tiny, fingerlike protrusions called villi lining the small intestine are damaged or destroyed.

Their role is to get

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nutrients from the food into the blood.

Without healthy villi, a person becomes malnourished, regardless of the quantity of food eaten.

Because the body's own immune system causes the damage, celiac disease is considered an autoimmune disorder.

However, it is also classified as a disease of malabsorption because nutrients are not absorbed.

Celiac disease runs in families.

Sometimes the disease becomes active for the first time after surgery, pregnancy, childbirth, viral infection, or severe emotional stress. Celiac disease affects people differently.

Symptoms may occur in the digestive system, or in other parts of the body.

For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.

Being constantly tired, weight changes, unexplained low blood count, brittle bones and even seizures are also some of the manifestations.

Certain people will have a peculiar rash, which looks somewhat like shingles. A person with celiac disease may have no symptoms. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications.

Researchers are studying the reasons celiac disease affects people differently.

The length of time a person is breast-fed, the age a person started eating gluten-containing foods, and the amount of glutencontaining foods one eats are three factors thought to play a role in when and how celiac disease appears. Some studies have shown, for example, that the longer a person was breast-fed, the later the symptoms of celiac disease appear and the more uncommon are the symptoms.

To diagnose celiac disease, physicians will usually test blood to measure levels of proteins that react against the body's own molecules or tissues. Doctors call them autoantibodies. If the tests and symptoms suggest celiac disease, the doctor will perform a small bowel biopsy. Since celiac disease is hereditary, family members, particularly firstdegree relatives - meaning parents, siblings, or children of people who have been diagnosed - may wish to be tested for the disease.

The only treatment for celiac disease is to follow a gluten-free diet. When a person is first diagnosed with celiac disease, the doctor usually will ask the person to work with a dietitian on a gluten-free diet plan.

Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.

For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet.

The small intestine is usually completely healed within two years for older adults.

In order to stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating any gluten, no matter how small an amount, can damage the small intestine.

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.