Fibromyalgia and Celiac Disease
Fibromyalgia and celiac disease are both frequently confused and often co-existing in the same patient. Celiac disease is a disease of the small intestine that results from hypersensitivity to the protein known as gluten. Gluten is commonly found in foods made from barley, wheat, and rye, including bread, pasta, cereals, and pizza. In addition, gluten may also be found in certain medicines, vitamins, and some cosmetic products. Those with celiac disease experience an internal allergic reaction within their small intestine each time they consume a food containing gluten, or use a medicine or product in which it is an ingredient. This immune reaction damages small, finger-like protuberances known as villi, which line the small intestine. Healthy villi are essential to nutrient absorption, therefore when they are damaged, an individual can quickly become malnourished regardless of the quantity of food consumed.
The cause of celiac disease is not known, and it can develop at any point during the lifespan, from infancy to adulthood. Much like fibromyalgia, the symptoms of celiac disease can vary between individuals, which makes an accurate diagnosis often difficult and lengthy to obtain. Common gastrointestinal symptoms include abdominal pain, bloating, gas, indigestion, constipation, changes in appetite, diarrhea, lactose intolerance, nausea and vomiting, stool irregularities, and unexplained weight loss. Additional symptoms that may arise over time are related to the nutritional deficiencies that result from celiac disease and include easily bruising, depression and anxiety, fatigue, delayed growth (in children), hair loss, itchy skin, missed menstrual periods, mouth ulcers, seizures, and tingling or numbness in the hands and feet. Like fibromyalgia, muscle and joint pain may also be present. Due to overlapping symptoms, fibromyalgia may commonly be mis-diagnosed as celiac disease and vice versa. In addition, individuals with fibromyalgia may also have celiac disease at the same time. Fortunately, celiac disease can generally be diagnosed by a special blood test and by examining a biopsy (tissue sample) of the small intestine for microscopic changes that are characteristic of the condition.
Blood tests can be used to detect exceptionally high levels of certain antibodies that recognize gluten as a foreign invader in the body. Antibodies are proteins in the immune system that work to eliminate foreign substances. If celiac disease is suspected, a physician may also want to view a small portion of the intestinal tissue under a microscope to check for microscopic damage that is characteristic of the disease. This can be done by inserting a thin, flexible tube known as an endoscope through the mouth, esophagus, and stomach into the small intestine. Sometimes, physicians may have patients swallow a small camera-containing pill that takes thousands of pictures while inside the body, and transmits them to a receiver the patient wears on a belt. The pill is naturally excreted through the stool.
Research on Fibromyalgia and Celiac Disease
There is limited data available regarding the statistical co-morbidities of fibromyalgia and celiac disease. Wallace and Hallegua performed a review of available studies to examine the relationship between fibromyalgia and gastrointestinal signs and symptoms. They found that patients who are diagnosed with celiac disease frequently also have a history of fibromyalgia (Wallace & Hallegua, 2004). Zipser and colleagues performed a large survey of adult celiac disease patients enrolled in a nationwide support group in the United States to determine how patients initially presented with their symptoms and the resulting initial diagnoses they received. Out of the 1,032 respondents, the authors found that much like fibromyalgia, the diagnosis of celiac disease was generally delayed, with a median time to diagnosis of 12 months, and some diagnoses delayed as long as 10 years. In addition, 9% of patients were diagnosed as having fibromyalgia prior to receiving the final diagnosis of celiac disease (Zipser et al., 2003). Although not applicable to adult populations, findings from a recent study published in the journal Pediatric Rheumatology examined the prevalence of asymptomatic celiac disease (i.e., celiac disease that did not manifest with any outward symptoms) among children who were diagnosed with fibromyalgia. Out of the 50 patients who participated in the study – all of whom met the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia, and who were between the ages of 12 and 17 – only one was diagnosed with concurrent celiac disease (Taubman et al., 2011).