What Is It?

Celiac disease (also called non-tropical sprue, celiac sprue and gluten-sensitive enteropathy) is an intestinal disorder in which gluten — a natural protein commonly found in many grains, including wheat, barley, rye and oats — cannot be tolerated by the body. In healthy people, gluten is digested like any other protein or nutrient, then absorbed through the fingerlike protrusions called villi (and the even tinier hairlike protrusions called microvilli) that make up the surface of the small intestine. But in people with celiac disease, gluten causes an immune reaction in the body, leading to inflammation and damage to the villi and microvilli of the small intestine. The result is that the intestine cannot absorb nutrients properly and the person can become malnourished.

Celiac disease is believed to be hereditary and is most common among people of northern European descent. As many as one in every 250 people in the United States may have celiac disease, but most cases go undiagnosed, often because the symptoms are assumed to be caused by other diseases or because symptoms are mild. Although many cases are diagnosed in childhood, celiac disease can be diagnosed at any age. It is believed that surgery, pregnancy, childbirth, viral infection or severe emotional stress can trigger symptoms of the disease in people who are predisposed genetically.

Celiac disease is considered to be an autoimmune condition because the body’s own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also tend to have an increased risk of developing other autoimmune diseases, such as type 1 diabetes (which usually requires insulin and is most common in children and young adults) and thyroid disease. Other conditions that may coexist with celiac disease include dermatitis herpetiformis (an itchy, blistering skin rash), Down syndrome, liver disease and immune-system abnormalities.

Because celiac disease affects different people differently, symptoms and severity can vary. Some symptoms may not seem related to the digestive system, but lack of nutrients can affect every part of the body.

Children generally develop symptoms only after they start eating foods that contain gluten. Common symptoms include:

• Upset stomach
• Failure to grow normally (often called “failure to thrive”) or delayed growth
• Weight loss
• Painful abdominal bloating or distention
• Pale, foul-smelling, greasy stools
• Chronic or recurrent diarrhea
• Irritability

In adults, symptoms may be mild or severe and can include:

• Chronic diarrhea that does not get better with medication
• Foul-smelly, greasy, pale stool
• Gassiness
• Recurring abdominal bloating
• Weight loss
• Fatigue
• Infertility, lack of menstruation
• Bone or joint pain
• Depression, irritability or mood changes
• Neurological problems, including weakness, poor balance, seizures, headaches or numbness or tingling in the legs
• Itchy, painful skin rash (dermatitis herpetiformis)
• Tooth discoloration or loss of enamel, sores on lips or tongue
• Other signs of vitamin deficiency, such as scaly skin or hyperkeratosis (from lack of vitamin A), or bleeding gums or bruising easily (from lack of vitamin K).

Celiac disease often is difficult to diagnose because the symptoms can be similar to those of other, more common diseases and may involve many parts of the body. In most cases, diagnostic tests for other gastrointestinal disorders will be ordered first to rule out other, more common causes of diarrhea or other symptoms before celiac disease is considered.

Once other diseases are ruled out, your health-care provider may recommend a biopsy of the intestine, in which a tiny portion of tissue is removed for examination under a microscope. The physician will look for damage to the tiny villi, which will appear flatter or more stunted than villi taken from a healthy intestine. He or she also will look for inflammatory cells often found beneath abnormal villi. If these changes are found, along with blood tests revealing typical antibodies and improvement after dietary change, the diagnosis is confirmed.

Blood tests to look for specific antibodies (anti-gliadin, anti-endomysial and anti-tissue transglutaminase) are very accurate for diagnosing celiac disease because these antibodies often are found in people with the disorder and rarely are found in healthy people. Because many people with celiac disease also have anemia, blood tests for iron deficiency also may be performed.

Celiac disease will last as long as gluten exposure continues. If a person with celiac disease follows a strict gluten-free diet, the intestines can heal and the disease can be controlled.

Because celiac disease is a genetic disorder, you cannot do anything to prevent it. Some studies suggest that if celiac disease runs in your family, you may be able to prevent or lessen the effects of the disease in your children by breast-feeding for as long as possible.

Symptoms and intestinal damage in a person diagnosed with celiac disease can be prevented by following a strict, gluten-free diet.

Effective treatment sounds simple: Just eliminate gluten from your diet, the symptoms will go away, and the intestinal damage will be cured. That’s easier said than done, however. So many of the foods Americans typically eat are gluten-rich, and gluten is found (but not necessarily labeled as such) in many prepared foods. Your health-care provider and organizations that specialize in celiac disease can give you guidelines on how to avoid gluten in your diet, and many cookbooks contain specific gluten-free recipes.

Here are some tips on avoiding gluten:

• Avoid cereals, breads or other grain products that include wheat, rye, barley or oats. This includes white or whole-wheat flour (including cookies, crackers, cakes and most other baked goods), semolina, couscous, bread crumbs, most pastas and malt.
• Avoid processed cheese, cheese mixes, low-fat or fat-free cottage cheese or sour cream.
• Avoid any dairy products, such as yogurt or ice cream, that contains fillers or additives.
• Avoid canned soups or soup mixes.
• Avoid creamed vegetables.
• Avoid products that contain modified food starch, food starch, hydrolyzed vegetable protein, stabilizers or fat replacers or substitutes.
• Avoid prepared or processed meats.
• Avoid beer, gin and whiskey.
• Avoid flavored coffee, malted milk or herbal tea with malted barley.
• Look for products marked “gluten-free.” As more attention is being given to this disease, more products are becoming available.
• Foods that do not contain gluten include products made with soybean or tapioca flours, rice, corn, buckwheat or potatoes. Nuts; fresh fish, meat or poultry; fresh, frozen or canned vegetables without sauces; wine; and plain, natural cheeses and yogurt are also gluten-free.
• Current evidence suggests up to 2 ounces of oats each day may be tolerated well by people with celiac disease.

If symptoms are not helped by restricting gluten, or if the inflammation in the intestine is severe, your health-care provider may prescribe corticosteroids, a powerful type of anti-inflammatory medication, for a short while to help the healing.

See your health-care provider if you have chronic diarrhea, chronic fatigue or weight loss that is unintentional or progressive. The most serious children’s symptoms, such as failure to thrive, likely will be discovered during routine check-ups, but call the pediatrician if your child develops unexplained weight loss, abdominal pain, prolonged diarrhea, recurrent abdominal bloating or seems to experience pain after eating.

Most people who follow a strict gluten-free diet can expect symptoms to improve in a few weeks, and the damage to the intestinal villi often is reversed in a few months. As long as the diet is followed, people with celiac disease should be able to lead normal lives with no further malabsorption symptoms.

Because the risks of another autoimmune disorder and bowel lymphoma (a cancer of the small intestine) are increased in people with celiac disease, your physician should consider these possibilities if new problems or symptoms occur.

Left untreated, celiac disease can lead to severe malnutrition and can put the patient at risk of several other diseases, including osteoporosis and seizures.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.