Celiac Disease

Celiac disease is an inherited genetic disorder that triggers an autoimmune reaction when gluten is consumed. This means that the body’s immune system attacks itself in response to the presence of gluten. Specifically, the attack damages the villi, which are small, fingerlike projections that line the small intestine.

Villi play an important role in digestion. They allow the nutrients in food to be absorbed through the walls of the small intestine into the bloodstream. When the villi are damaged, nutrients cannot be absorbed properly into the body, which leads to malnourishment. When this happens, the function of other body organs may be affected, as well.

Symptoms of celiac disease can vary from person to person and include both gastrointestinal (GI) and non-GI symptoms. Infants and young children are more likely to have digestive symptoms, while adults are more likely to experience non-digestive symptoms.

GI symptoms may include:

• Abdominal pain
• Gas and bloating
• Diarrhea
• Constipation
• Nausea and vomiting
• Weight loss
• Changes in bowel movements

Non-GI symptoms may include:

• Muscle cramps
• Arthritis and joint pain
• Osteoporosis and bone fractures
• Iron-deficiency anemia
• Skin disorders
• Hair loss
• Discolored teeth with enamel problems
• Depression
• Irritability
• Fatigue
• Difficulty breathing
• Low blood sugar
• Hormonal changes in women and men
• Infertility in women and men
• Miscarriage in women
• Impotence in men
• Behavior problems and impaired growth in children

Diagnosing celiac disease can be difficult because symptoms may be similar to those of other diseases, such as irritable bowel syndrome (IBS), inflammatory bowel disease, and lactose intolerance. Your doctor will begin by reviewing your medical history and conducting a physical examination. Be sure to tell your doctor about your symptoms, what you typically eat, and your risk factors for celiac disease.

Your doctor will also order tests, which may include blood tests, genetic tests, and a biopsy.

Because celiac disease is an autoimmune disorder, the blood contains higher-than-normal levels of certain autoantibodies, including anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA).

If these tests are positive for celiac disease, your doctor may perform an upper endoscopy, or esophagogastroduodenoscopy (EGD), to obtain a sample (biopsy) of your small intestine. If the villi display structural and functional changes, the doctor can confirm the diagnosis.

The treatment for celiac disease is to follow a gluten-free diet and avoid personal care products that contain gluten. If not treated, celiac disease can cause serious medical complications, including an increased risk for developing cancer.

To help you eliminate gluten and eat healthy, nutritional foods, your doctor may recommend that you meet with a dietitian. A dietitian can educate you about reading product labels and identifying foods that contain gluten, so you can make informed decisions at the grocery store and when eating out.

For most people with celiac disease, following a gluten-free diet will improve symptoms within a few days. In children, the small intestine typically heals within three to six months, while it may take up to two years or longer in adults.

Unfortunately, people with celiac disease are at higher risk for other autoimmune disorders, including:

• Type 1 diabetes
• Autoimmune thyroid disease (Hashimoto’s)
• Autoimmune liver disease (hepatitis)
• Rheumatoid arthritis
• Addison's disease, a condition in which the glands that produce critical hormones are damaged
• Sjögren's syndrome, a condition in which the glands that produce tears and saliva are destroyed

The later a person is diagnosed with celiac disease, the greater the chance of developing another autoimmune disorder.