Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.
If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine’s lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.
Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.
When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
What Is Celiac Disease?
Celiac disease is:
- A serious autoimmune disease
- Triggered by consuming a protein called gluten, which is found in wheat, barley and rye
When a person with celiac disease eats the protein gluten, the immune system sees gluten as a threat and begins to attack it. The villi of the intestines, which are trying to digest the gluten along with other food, get damaged in the process. Damaged villi make it nearly impossible for the body to absorb nutrients, leading to malnourishment. If someone with celiac disease continues to eat gluten they can experience a host of other problems including osteoporosis, infertility, and the onset of other autoimmune diseases, like diabetes type 1, thyroid disease, and Sjögren’s.
Left untreated, people with celiac disease are at-risk for serious health consequences. There is currently no cure for celiac disease and the only treatment is a strict gluten-free diet.
Symptoms of Coeliac Disease
Celiac disease symptoms usually involve the intestines and digestive system, but they can also affect other parts of the body. Children and adults tend to have a different set of symptoms.
Celiac disease symptoms in children
Children with celiac disease can feel tired and irritable. They may also be smaller than normal and have delayed puberty. Other common symptoms include:
- weight loss
- abdominal bloating
- abdominal pain
- persistent diarrhea or constipation
- pale, fatty, foul-smelling stools
Celiac disease symptoms in adults
Adults with celiac disease may experience digestive symptoms. In most cases, however, symptoms also affect other areas of the body. These symptoms may include:
- iron-deficiency anemia
- joint pain and stiffness
- weak, brittle bones
- skin disorders
- numbness and tingling in the hands and feet
- tooth discoloration or loss of enamel
- pale sores inside the mouth
- irregular menstrual periods
- infertility and miscarriage
Dermatitis herpetiformis (DH) is another common symptom of celiac disease. DH is an intensely itchy skin rash made up of bumps and blisters. It may develop on the elbows, buttocks, and knees. DH affects approximately 15 to 25 percent of people with celiac disease. Those who do experience DH usually don’t have digestive symptoms.
It’s important to note that symptoms can vary from person to person depending on various factors, including:
- the length of time someone was breast-fed as an infant
- the age someone started eating gluten
- the amount of gluten someone eats
- the severity of intestinal damage
- Some people with celiac disease have no symptoms. However, they may still develop long-term complications as a result of their disease.
Schedule an appointment with your doctor right away if you suspect that you or your child has celiac disease. When diagnosis and treatment are delayed, complications are more likely to occur.
What Causes Celiac Disease?
Research suggests that celiac disease only occurs in people who have certain genes and eat food that contains gluten. Experts are studying other factors that may play a role in causing the disease.
Celiac disease almost always occurs in people who have one of two groups of normal gene variants NIH external link, called DQ2 and DQ8. People who do not have these gene variants are very unlikely to develop celiac disease. About 30 percent of people have DQ2 or DQ8. However, only about 3 percent of people with DQ2 or DQ8 develop celiac disease.
Researchers are studying other genes that may increase the chance of developing celiac disease in people who have DQ2 or DQ8.
Consuming gluten triggers the abnormal immune system response that causes celiac disease. However, not all people who have the gene variants DQ2 or DQ8 and eat gluten develop the disease. Research suggests that among children with a genetic predisposition for celiac disease, those who eat more gluten in early childhood may have a greater risk for celiac disease.
Researchers are studying other factors that may increase a person’s chances of developing celiac disease. For example, research suggest that a higher number of infections in early life and certain digestive tract infections may increase the risk. Experts also think changes in the microbiome—the bacteria in the digestive tract that help with digestion—could play a role in the development of celiac disease.
The disease is most common among Caucasians and people who have other diseases, including:
- Hashimoto’s thyroiditis
- Type 1 diabetes
- Addison’s disease
- Down syndrome
- Rheumatoid arthritis
- Turner syndrome (a condition in which a female is missing an X chromosome)
- Multiple sclerosis (MS)
- Autoimmune hepatitis
- Sjogren’s syndrome
- Idiopathic dilated cardiomyopathy
- IgA nephropathy
- Irritable bowel syndrome (IBS)
- Chronic pancreatitis
- Williams syndrome
- Primary biliary cirrhosis
- Lactose intolerance
- Intestinal lymphoma
- Intestinal cancer
How Is Celiac Disease Diagnosed?
A number of tests can help your doctor figure out whether you have celiac disease or another digestive condition.
Per the Mayo Clinic, your doctor may recommend:
- Blood Tests Your blood sample will be checked for special proteins called antibodies. Certain antibodies tend to be elevated in people with celiac disease. Before your blood test, you should continue to eat foods containing gluten. Cutting out gluten before testing is complete could delay your diagnosis.
- Endoscopy Your doctor may ask a gastroenterologist to perform an endoscopy to confirm your diagnosis if a blood test shows you may have celiac disease. You’ll swallow a small, flexible tube containing a tiny camera. Through this tube, your doctor will perform a biopsy, removing a tiny piece of tissue from the wall of your small intestine. A specialist (usually a pathologist) will view this tissue under a microscope to see whether it has been damaged by celiac disease.
- Genetic Testing Your doctor may order a genetic test to rule out a celiac disease diagnosis. Most people with celiac disease carry a certain variant of the HLA-DQ2 or -DQ8 genes. But many people without celiac disease also have these variants, so celiac disease can’t be diagnosed by genetic testing alone.
- Bone Density Testing If you have celiac disease, your doctor will probably recommend a test to check for bone loss. This may not happen until you’ve been following a gluten-free diet for a year. This test uses a scanning machine similar to an X-ray. If the scan shows significant bone loss, you may need dietary supplements or other treatments to encourage bone growth.
How Is Celiac Disease Treated?
The only way to treat celiac disease is to permanently remove gluten from your diet. This allows the intestinal villi to heal and to begin absorbing nutrients properly. Your doctor will teach you how to avoid gluten while following a nutritious and healthy diet. They will also give you instructions on how to read food and product labels so you can identify any ingredients that contain gluten.
Symptoms can improve within days of removing gluten from the diet. However, you shouldn’t stop eating gluten until a diagnosis is made. Removing gluten prematurely may interfere with test results and lead to an inaccurate diagnosis.
Following a gluten-free diet means you cannot eat many “staples,” including pasta, cereals and many processed foods that contain gluten. There may also be gluten in ingredients added to food to improve texture or flavor and in some medicines. Some less obvious sources of gluten may include ice cream and salad dressing. Cross-contamination is another common source of gluten which happens when gluten-free foods come accidentally into contact with gluten.
If you have celiac disease, you can still eat a well-balanced diet. For instance, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available. Food companies and some grocery stores also carry gluten-free bread and products.
You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats and fish, since these do not contain gluten.
No drugs treat celiac disease. The best thing you can do is change your diet.
Unless they’re labeled as gluten-free, don’t eat foods that are typically made with grains, including:
- Bread, cake, and other baked goods
- Pasta or noodles
- Sauces and gravies
These grains always have gluten:
- Einkorn wheat
- Brewer’s yeast
- Wheat starch
People with celiac disease need to check labels carefully. Many processed foods sometimes have gluten:
- Granola or energy bars
- French fries
- Potato chips
- Lunch meats
- Candy or candy bars
- Salad dressings and marinades
- Meat substitutes such as seitan or veggie burgers
- Soy sauce
These foods are always gluten-free:
- Meat and poultry
- Fish and other seafood
- Beans and nuts
Gluten-free starches and grains include:
- Corn or maize
- Nut flours
Common products like medications and toothpastes can also contain gluten, so it’s important to check the label.
If you have a serious lack of nutrients, your doctor may have you take gluten-free vitamins and mineral supplements and will give you medication if you have a skin rash.
After you’ve been on a gluten-free diet for a few weeks, your small intestine should begin to heal, and you’ll start to feel better.
Prevention of Celiac Disease
At this time, there is no proven way to prevent celiac disease.
The best way to keep symptoms of celiac disease under control is to maintain a gluten-free diet.