Celiac Disease

Overview

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.

In children, malabsorption can affect growth and development, besides causing the symptoms seen in adults.

There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing

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:

• Abdominal pain
• Anemia
• Bloating or a feeling of fullness
• Bone or joint pain
• Constipation
• Diarrhea
• Gas
• Heartburn
• Itchy, blistery rash (doctors call this dermatitis herpetiformis)
• Headaches or fatigue
• Mouth ulcers
• Nausea
• Nervous system injury, including numb or tingling hands or feet, balance problems, or changes in awareness
• Poop that’s pale, smells especially bad, or floats (steatorrhea)
• Weight loss
• 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:
• Anemia
• Damaged tooth enamel
• Delayed puberty
• Failure to thrive, in infants
• Crankiness or mood changes
• Neurological problems like learning disabilities and attention deficit hyperactivity disorder (ADHD)
• Slow growth and short height
• 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
• risk for celiac disease

Celiac disease runs in families. According to the University of Chicago Medical Center, people have a 1 in 22 chance of developing celiac disease if their parent or sibling has the condition.

People who have other autoimmune diseases and certain genetic disorders are also more likely to have celiac disease. Some conditions associated with celiac disease include:

• lupus
• rheumatoid arthritis
• type 1 diabetes
• thyroid disease
• autoimmune liver disease
• Addison’s disease
• Sjogren’s syndrome
• Down syndrome
• Turner syndrome
• lactose intolerance
• intestinal cancer
• intestinal lymphoma

Causes

Celiac disease is an autoimmune disorder. When a person who has it eats gluten, their immune system attacks and damages their small intestine.

Over time, finger-like projections in the intestine that absorb nutrients, called villi, get damaged, limiting the overall absorption. This can lead to a number of health issues.

Celiac disease can develop in anyone. It is more common Trusted Source in white people and in females.

Also, it runs in families. A person with a parent or sibling who has celiac disease has a 1 in 10 chance of developing it, too.

Celiac disease is more common in people with other conditions, including:

• Down syndrome
• Turner syndrome
• type 1 diabetes

DIAGNOSIS AND TESTS

If your healthcare provider thinks you might have celiac disease, they will perform a careful physical examination and discuss your medical history with you. The provider may also perform a blood test to measure levels of antibodies to gluten. People with celiac disease have higher levels of certain antibodies in their blood. Sometimes having a genetic test for celiac disease in the blood may be necessary.

Your provider may perform other tests to look for nutritional shortages, such as a blood test to detect iron levels. A low level of iron (which can cause anemia) can occur with celiac disease.

Your provider may take a biopsy from your small intestine to check for damage to the villi. In a biopsy, the doctor inserts an endoscope (a thin, hollow tube) through your mouth and into the small intestine and takes a sample of the small intestine with an instrument. This is done with sedation or anesthesia to avoid any discomfort during the procedure.

MANAGEMENT AND TREATMENT

If you have celiac disease, you can't eat any foods that contain gluten (including wheat, rye and barley). You will be encouraged to visit with a dietitian for formal diet instruction. Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. However, the villi usually require months to years to complete healing. It might take two to three years for the intestines to heal in an adult, compared to about six months for a child.

You'll need regular medical follow-up visits (usually at 3 months, 6 months, and then every year) and have to remain on this diet for the rest of your life. Eating even a small amount of gluten can damage your intestine and restart the problem.

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.

PREVENTION

Celiac disease cannot be prevented. However, early detection and management of celiac disease may prevent severe complications. Therefore, it is very important to check for celiac disease in persons at higher risk for having the condition, such as first-degree family members of patients with celiac disease

OUTLOOK / PROGNOSIS

The outlook for people with celiac disease varies. After adequate treatment and regular medical follow-up, the prognosis is excellent. People who are not treated or who do not respond to treatment may suffer some complications of the disease or even die earlier than what is generally considered normal. However, celiac disease is rarely fatal—most people who are diagnosed and who do not eat gluten do well.

LIVING WITH

A gluten-free diet will be a big change in your life (a good and necessary change if you have celiac disease). You have to rethink your eating habits, including what you buy for lunch, what you eat at parties, or what you snack on. When you go grocery shopping, be sure to read the ingredient labels carefully to avoid accidental gluten ingestion. If after reading labels you are not sure about gluten content, it is not safe for you.

A dietitian, a healthcare professional who specializes in food and nutrition, can help you with the gluten-free diet. There are also support groups that can help patients who have just been diagnosed with celiac disease.