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July 8, 2015

Celiac Disease

Celiac disease is an autoimmune disorder estimated to affect 1 in 100 people worldwide. It is also known as gluten sensitive enteropathy, celiac sprue, or nontropical sprue. Celiac is a condition where the immune system responds abnormally to a protein called gluten. Gluten is a type of protein. It is found in grains like: wheat, barley, rye, and many types of prepared food. This condition can cause damage to the lining of the small intestine. The small intestine is responsible for absorbing food and nutrients. Thus, damage to the lining of the small intestines can lead to difficulty absorbing important nutrients; this problem is referred to as malabsorption.

It is important to seek treatment if you or a loved one may have Celiac. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.


It is not clear what causes celiac disease. A combination of environmental and genetic factors may be associated with celiac. For instance, you are more likely to have these genes if you have a first-degree relative like a: mother, father, brother, sister, son, or daughter who has celiac disease. In addition, some environmental factors, such as, infections, may trigger changes in the small intestine of a person with these genes.

Risk Factors

Celiac can affect anyone, nevertheless it is more common with those who have conditions such as: Type 1 Diabetes, Down Syndrome, Turner’s Disease, Autoimmune Thyroid disease, Sjogren’s syndrome or Microscopic Colitis.

In addition, eating foods that contain gluten can trigger an abnormal immune system response causing Celiac. Over time, this response can cause digestion and absorption problems.

Signs & Symptoms

Signs and symptoms can vary enormously from person to pperson. Some may experience no symptoms , other numerous symptoms. Digestive symptoms include: diarrhea, weight loss, and constipation.

Other signs ands symptoms include:

  • Anemia, resulting in iron deficiency
  • Loss of bone density
  • Itchy, blistery skin rash
  • Damage to dental enamel
  • Headaches and fatigue
  • Nervous system injury
  • Joint Pain
  • Reduced functioning of the spleen
  • Acid reflux and heartburn

Screenings & Diagnostic Tests

Celiac disease can be difficult to diagnose because the signs and symptoms are similar to other conditions. Fortunately, testing is available that can distinguish celiac disease from other disorders.

Blood tests — A blood test can determine the blood level of antibodies (proteins) that become elevated in people with celiac disease. Over 90 percent of people with untreated celiac disease have elevated antibody levels, while these levels are rarely elevated in those without celiac disease. Before having these tests, it is important to continue eating a normal diet, including foods that contain gluten. Avoiding or eliminating gluten could cause the antibody levels to be normal, delaying the diagnosis.

Small intestine biopsy — If your blood test is positive, the diagnosis must be confirmed by examining a small sample of the intestinal lining with a microscope. The sample (called a biopsy) is usually collected during an upper-endoscopy. In people with celiac disease, the lining of the small intestine has a characteristic appearance when viewed with a microscope. Normally, the lining has distinct finger-like structures, which are called villi. Villi allow the small intestine to absorb nutrients. The villi become flattened in people with celiac disease. Once you stop eating gluten, the villi can resume a normal growth pattern. Roughly 70% of people begin to feel better within two weeks after stopping gluten.

"Potential" celiac disease — People with a positive IgA endomysial antibody test and/or a positive IgA-tTG test and a normal small bowel biopsy are considered to have potential celiac disease. People with potential celiac disease are NOT usually advised to eat a gluten free diet. However, ongoing monitoring (with a blood test) is recommended and a repeat biopsy may be needed if you develop symptoms. Biopsies should be taken from several areas in the bowel since the abnormality can be patchy.

"Silent" celiac disease — If you have a positive blood test for celiac disease and an abnormal small bowel biopsy, but you have no other symptoms of celiac disease, you are said to have "silent" celiac disease. It is not clear if people with silent celiac disease should eat a gluten free diet. Blood tests for malabsorption are recommended.

Testing for malabsorption — You should be tested for nutritional deficiencies if your blood test and bowel biopsy indicates celiac disease. Common tests include measurement of iron, folic acid, or vitamin B12, and vitamin D. You may have other tests if you have signs of mineral or fat deficiency, such as changes in taste or smell, poor appetite, changes in your nails, hair, or skin, or diarrhea.

Other tests — Other standard tests include a CBC (complete blood count), lipid levels (total cholesterol, HDL, LDL, and triglycerides), and thyroid levels. Once your celiac antibody levels return to normal, you should have a repeat test once per year.


Permanently removing gluten from the diet is the only treatment for celiac disease. This allows the intestinal villi to heal and improves absorption of nutrients. Untreated celiac disease can cause severe malnutrition and can develop into other autoimmune diseases and cancer.

Gluten free diet — The cornerstone of treatment for celiac disease is complete elimination of gluten from the diet for life. Gluten is the group of proteins found in wheat, rye and barley that are toxic to those with celiac disease. Gluten is not only contained in these most commonly consumed grains in the Western world; it is also hidden as an ingredient in a large number of prepared foods, as well as medications and supplements. Strict gluten avoidance is recommended since even small amounts can aggravate the disease. It is important to avoid both eating gluten and being exposed to it in the air.

Get help from a dietitian — Working with an experienced celiac dietitian can help you to learn how to eat a gluten free diet, what foods to avoid, and what foods to add for a nutritionally balanced diet. Your celiac dietitian can also educate you on shopping, food preparation and lifestyle resources. Excellent resources are also available from celiac medical centers, organizations, and support groups.

Treatment Outlook

Most patients who have celiac disease start to feel better after begining the gluten-free diet. Restoration of the small intestine begins instantaneously. Patients who start a stringent, gluten-free diet closely after diagnosis have the best chance of living a healthy and active life. Full recovery can take a few months to several years. Persons who have Celiac should be examined frequently by a physician.

More Resources:

What is Celiac Disease?


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Additional Information

Celiac Disease 101