Celiac Disease

What Is Celiac Disease?

Celiac disease is an autoimmune disorder that’s triggered when you eat gluten. It’s also known as celiac sprue, nontropical sprue, or gluten-sensitive enteropathy.

Gluten is a protein in wheat, barley, rye, and other grains. It’s what makes dough elastic and gives bread its chewy texture.

When someone with celiac disease eats something with gluten, their body overreacts to the protein and damages their villi, small finger-like projections found along the wall of their small intestine.

When your villi are injured, your small intestine can’t properly absorb nutrients from food. Eventually, this can lead to malnourishment, as well as loss of bone density, miscarriage, infertility or even neurological diseases or certain cancers.

If your celiac disease isn’t better after at least a year without gluten, it’s called refractory or nonresponsive celiac disease.

Most people with celiac disease never know that they have it. Researchers think that as few as 20% of people with the disease get the right diagnosis. The damage to your intestine is very slow, and symptoms are so varied that it can take years to get a diagnosis.

Celiac disease isn’t the same thing as gluten intolerance or gluten sensitivity. People with gluten intolerance may have some of the same symptoms and may want to avoid gluten. But they don’t show an immune response or damage to the small intestine.

Celiac Disease Symptoms

Celiac disease isn’t the same thing as a food allergy, so the symptoms are different.

If you’re allergic to wheat but eat something with wheat in it, you may have itchy or watery eyes or a hard time breathing.

Celiac disease symptoms in adults

If you have celiac disease and accidentally eat something with gluten in it, you may have symptoms including:

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Celiac disease can also cause a loss of bone density and reduced spleen function (hyposplenism).

Celiac disease symptoms in children

Children with celiac disease are more likely to have intestinal problems, including:

  • Bloating or belly swelling
  • Constipation
  • Diarrhea
  • Pale, foul-smelling poop
  • Upset stomach or vomiting
  • Weight loss

If celiac disease keeps a child’s body from absorbing the nutrients they need, they can have problems including:

Not everyone with celiac disease will have these symptoms. Some people don’t notice any problems, which can make diagnosis difficult.

Celiac rash (dermatitis herpetiformis)

About 1 in 4 people with celiac disease get an itchy, blistering rash. It happens more in adults than children, and more in men than women. It’s most common in these areas:

  • Buttocks
  • Elbows
  • Knees
  • Scalp
  • Lower back

Celiac Disease Causes and Risk Factors

Research hasn’t found a definite cause of celiac disease. It tends to run in families and might be linked to certain genes. Stressful medical events such as a viral infection or surgery can trigger it. So can emotional trauma or pregnancy.

If one of your close family members has it, like a parent or sibling, you have a 1 in 10 chance of getting celiac disease.

The disease is most common among Caucasians and people who have other diseases, including:

Celiac Disease Complications

Celiac disease can be dangerous if you don’t get treatment. Complications may include:

  • Cancer, including intestinal lymphoma and small bowel cancer
  • Damaged tooth enamel
  • Infertility and miscarriage
  • Lactose intolerance
  • Malnutrition
  • Nervous system problems like seizures or pain and numbness in your hands and feet (peripheral neuropathy)
  • Pancreatic disease
  • Weak bones

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Celiac Disease Tests and Diagnosis

Doctors use blood tests and other tests to help find out if you have celiac disease:

  • Serology tests look for certain antibodies.
  • Blood tests check other parts of your immune system.
  • Intestinal fatty acid binding protein tests show if there’s damage to the intestine.
  • A complete blood count looks for anemia (low red blood cells).
  • C-reactive protein tests show if there’s inflammation.
  • Metabolic panels test liver and kidney function.
  • Vitamin D, B12, and folate tests look for vitamin deficiencies.
  • Iron and ferritin tests look for iron deficiency.
  • Swallowing a small camera can show problems in your digestive tract.
  • Imaging tests show signs in the intestine, like wall thickening or changes to blood vessels.
  • Genetic testing looks for human leukocyte antigens to rule out celiac disease.

If you're on a gluten-free diet, you'll need to come off it before having the antibody test so the results will be correct.

If blood and other tests show that you might have celiac disease, you’ll probably need to have an endoscopy. This procedure lets your doctor look at your small intestine and take a bit of tissue to see whether it’s damaged.

If you have a rash, doctors will take a small sample of your skin to look for signs it’s caused by celiac disease. This rash is easy to confuse with other skin problems.

Celiac Disease Treatment and Diet

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:

  • Beer
  • Bread, cake, and other baked goods
  • Cereals
  • Pasta or noodles
  • Crackers
  • Breading
  • Pancakes
  • Sauces and gravies

These grains always have gluten:

  • Wheat
  • Wheatberries
  • Durum
  • Semolina
  • Spelt
  • Farina
  • Farro
  • Graham
  • Einkorn wheat
  • Rye
  • Barley
  • Malt
  • 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
  • Soup
  • Salad dressings and marinades
  • Meat substitutes such as seitan or veggie burgers
  • Soy sauce

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These foods are always gluten-free:

  • Fruits
  • Vegetables
  • Meat and poultry
  • Fish and other seafood
  • Dairy
  • Beans and nuts

Gluten-free starches and grains include:

  • Rice
  • Corn or maize
  • Soy
  • Potato
  • Tapioca
  • Beans
  • Sorghum
  • Quinoa
  • Millet
  • Amaranth
  • Flax
  • Chia
  • 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.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 07, 2020

Sources

SOURCES:

Mayo Clinic: "Celiac Disease," “Peripheral Neuropathy.”

Beyond Celiac: "What is Celiac Disease?" “Non-responsive Celiac Disease.”

National Institute of Diabetes and Digestive and Kidney Diseases: "Definition and Facts for Celiac Disease."

Celiac Disease Foundation: "Understanding Celiac Disease," “What is Celiac Disease?” “Testing.” “Autoimmune Disorders,” “Sources of Gluten,” “Gluten-Free Foods.”

Harvard Health Publishing: “Celiac Disease (Non-Tropical Sprue).”

National Organization for Rare Disorders: “Refractory Celiac Disease.”

Cedars Sinai: “Is Eating Gluten-Free a Good Idea?”

Beyond celiac: “Dermatitis Herpetiformis,” “Celiac Disease Related Conditions and Diseases.”

UChicago Medicine Celiac Disease Center: “What other autoimmune disorders are typically associated with those who have celiac disease?”

Lab Tests Online: “Celiac Disease Antibody Tests.”

Northwestern Medicine: “Celiac Disease vs. Gluten Intolerance (Infographic).”

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