Your small intestine is lined with tiny, finger-shaped tissues called villi. The villi create a large surface that absorbs vitamins, sugars, and other nutrients as food passes through the small intestine. When a person who has celiac disease eats gluten, the villi flatten out and the intestinal lining becomes damaged. This decreases the area that can absorb nutrients.
In some cases, this inability to absorb nutrients may be bad enough to stunt growth and weaken bones. The loss of vitamins and minerals may lead to other problems, such as anemia, osteoporosis, or growth delays in children.
People who have celiac disease may have periods when their symptoms seem worse. Or symptoms may sometimes not be noticed at all. In adults, symptoms may occur at any age but most commonly occur during the 20s, 30s, and 40s.
Sometimes a person who has celiac disease doesn't have symptoms after eating foods that contain gluten. But damage to the small intestine is still occurring.
Within 2 weeks after starting a gluten-free diet, most people with celiac disease find that their symptoms improve. Symptoms should completely disappear within 3 months. But it takes up to 6 months or longer on a gluten-free diet for the villi to return to normal.
Staying on a gluten-free diet usually keeps symptoms from returning and lowers the risk for complications.
In rare cases, a gluten-free diet doesn't help. Some people get better for a while, but their symptoms come back even though they are still eating a gluten-free diet. This condition is called refractory sprue.
In these cases, corticosteroids or other medicines that change the immune system response may be used to control symptoms. People who do not improve on a gluten-free diet should be tested for other conditions.
Celiac disease in children
In some children, symptoms begin shortly after cereal is introduced into the diet, usually after 6 months of age.
Symptoms of the disease are controlled by adopting a gluten-free diet. But a child needs to be watched for:
- Delayed growth. Children with celiac disease don't absorb needed nutrients if they eat gluten. This may result in delayed growth if gluten is eaten regularly over a long period.
- Nutritional deficiencies. Eating gluten also can lead to an imbalance of chemicals, minerals, and vitamins. These deficiencies should reverse with a gluten-free diet. But vitamins, iron, or calcium supplements are sometimes needed.
- Tumors. As children who have celiac disease grow into adulthood, they may be at a slightly increased risk for getting cancer (lymphoma). Studies have found that following a gluten-free diet lowers the risk for lymphoma in adults.1
Children who have untreated celiac disease can become very ill. They may need to go to the hospital for treatment with fluids and medicine to restore nutrients. These treatments are usually short-term. Most children recover completely.