Celiac disease, an autoimmune disease that affects the small intestine, affects about 1 in 133 people. More than 2.2 million individuals in the United States have the disease but have not been diagnosed. Genetic factors are involved in the development of the disease. Celiac disease may be activated in response to trauma, surgery, pregnancy or viral infection. Occasionally, it is linked to dermatitis herpetiformis, a skin disease characterized by an itchy, blistering rash.
In Celiac Disease the body’s immune system reacts abnormally to gluten ‒ a protein found in wheat, rye and barley. This immune response damages the villi, which line the small intestine and absorb nutrients. The damage can lead to diarrhea, malnutrition and other symptoms. Though there is no cure for celiac disease, its symptoms are reversible with lifelong gluten avoidance.
Celiac Disease Risk Factors and Symptoms
Risk factors for celiac disease include:
- family members with celiac disease
- Northwestern European ancestry
- history of another autoimmune disease, such as: lupus, type 1 diabetes, rheumatoid arthritis or dermatitis herpetiformis
Symptoms of celiac disease usually begin between the ages of 10 and 40, and vary from person to person. Individuals with celiac disease may have no symptoms or have one or more of the following:
- chronic diarrhea/constipation
- abdominal bloating and gas
- light-colored, oily, foul smelling stool
- weight loss with a large appetite
- joint pain
- leg numbness/tingling
- mouth sores
- tooth enamel defects
- itchy rash (dermatitis herpetiformis)
- behavior changes
- delayed growth and failure to thrive (in infants and children)
- abnormal liver function tests
Celiac Disease Diagnosis
- Blood tests. Those affected by celiac disease usually have higher than normal levels of certain antibodies produced by the immune system in response to gluten. Also, blood tests to check for vitamin and mineral deficiencies can be done to look for side effects caused by celiac disease.
- Endoscopy with biopsy. This procedure involves passing a thin flexible tube down the throat and beyond the stomach to the small intestine. Multiple biopsies are taken of the small intestine through a port on the endoscope. These biopsies are evaluated for flattening (damage) of the villi. This is the only definitive way of diagnosing celiac disease.
- Repeat endoscopy. Approximately six months after starting a gluten-free diet, some patients may undergo a repeat endoscopy to evaluate their response to the diet. An improvement in the appearance of the small bowel lining suggests successful treatment.
Celiac Disease Treatment
The only treatment for celiac disease is a lifelong gluten-free diet. This dietary change usually leads to improvement in a period of days to months. Also, people may be lactose intolerant until the small intestine heals.
Avoidance of gluten can be challenging in many ways. It requires careful review of all food, beverage and medication labels. Products labeled “wheat-free” aren’t necessarily free of gluten. Gluten is often used as a filler in many store-bought and restaurant-prepared foods. Pay close attention to nutritional labels on packaged food and beverages and ask your server about gluten-free products on restaurant menus when placing your order. Also, be aware that cross contamination with gluten can occur on the conveyer belts in food manufacturing plants or in restaurants.
Foods to Avoid
- oats (in most people)
Unexpected Sources of Gluten
- modified food starch (if not specified as wheat or corn)
- soups, broth and bouillon cubes
- soy sauce
- beer, ale and lager
- hydrolyzed vegetable or plant protein
- commercially-prepared salad dressings
- veined cheeses such as bleu and gorgonzola
For More Information
For more information or to schedule an appointment with a gastroenterologist, please call 847.657.1900.