What is celiac disease?

Celiac disease is a digestive disease that damages the small intestine because of sensitivity to gluten (the protein faction found in wheat, rye, barley and oats). This hereditary disorder interferes with the absorption of nutrients from food.

When persons with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.

What are the symptoms of celiac disease?

Celiac disease affects people in different ways. Some persons may develop symptoms as children, whereas others do not experience symptoms until adulthood. Some may have diarrhea and abdominal pains, while others have irritability or depression with the onset of the disease.

The following are common symptoms of celiac disease.  However, each individual may experience symptoms differently. Symptoms may include:

• chronic diarrhea
• weight loss
• recurring abdominal pain and bloating
• gas
• pale, foul-smelling stool
• unexplained anemia
• muscle cramps and/or bone pain
• pain in the joints
• tingling numbness in the legs
• delayed growth
• fatigue
• painful skin rash
• missed menstrual periods (which is linked to excessive weight loss)
• tooth discoloration or loss of enamel

Sometimes, persons with celiac disease are asymptomatic, as the undamaged part of the small intestine is still able to absorb enough nutrients. However, these persons are still at risk for complications of the disease.

What causes celiac disease?

Celiac disease is a genetic disease that runs in families. A person can have the disease and not know it until it is triggered by severe stress, pregnancy, surgery, physical injury, infection or childbirth.

Who gets celiac disease?

Celiac disease is more common in people of European descent or if another family member has been diagnosed with the disease. 

Also individuals who may have one or more of the following disorders are at greater risk: lupus, type I diabetes, rheumatoid arthritis, down’s syndrome, autoimmune thyroid disease and microscopic colitis

How is celiac disease related to inflammatory bowel disease?

Rarely, patients who have ulcerative colitis or Crohn’s disease may also have celiac disease at the same time.  Patients who have a particular form of inflammatory bowel disease, called microscopic colitis (a disease in which the colon looks normal on endoscopy but has inflammation when tissue biopsies from the colon are examined under a microscope) are at increased risk of having celiac disease.   Additionally, the symptoms of celiac disease are similar to those of Crohn’s disease and ulcerative colitis. 

How is celiac disease diagnosed and treated?

The symptoms of celiac disease are similar to those of other digestive diseases, it can be difficult to diagnose.  In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include the following: 

• Blood work (to measure the level of antibodies to gluten)
  Researchers have found that persons with celiac disease have higher than normal levels of certain antibodies in their blood. These antibodies by the immune system in response to substances (such as gluten) that the body perceives as threatening.
• Biopsy
  To diagnose celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. During the procedure, the physician eases a long, thin tube, called an endoscope, through the mouth and stomach into the small intestine. A sample of tissue is then taken using instruments passed through the endoscope.

Specific treatment for celiac disease will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance of specific medicines, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

A gluten-free diet is the only treatment for persons with celiac disease. Adhering to a gluten-free diet is a lifetime requirement, as eating any gluten will further damage the intestine.  For most persons, eliminating gluten from their diet will stop symptoms, heal intestinal damage that has already occurred, and prevent further damage.

If you think you have celiac disease, contact your gastroenterologist as soon as possible.