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Celiac Disease

Aria Health Center for Gynecology & Women's Health

Celiac disease is a condition in which the small intestine suffers damage as a result of sensitivity to gluten, which is found in wheat, rye, barley, and oats. This hereditary disorder interferes with nutrient absorption in the digestive tract.

When persons with celiac disease eat foods containing gluten, their immune system responds by producing an inflammation on the surface of the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.

Celiac disease is the most common genetic disease in certain European countries. Recent studies have suggested that it is significantly under-diagnosed in the U.S.

The many potential complications from celiac disease are those associated with damage to the small intestine and nutrient malabsorption, including osteoporosis, cancer, nerve damage, seizures, infertility, short stature if the disease develops at an early age, as well as miscarriage and congenital malformation of babies born to mothers who have the disease.


Causes/risk factors

Celiac disease is a genetic disease that runs in families. A person can have the disease and not know until it is triggered by severe stress, pregnancy, surgery, physical injury, infection, or childbirth.

Signs & symptoms

Celiac disease affects people in different ways. Some people may develop symptoms as children, whereas others do not experience symptoms until adulthood. Some may have diarrhea and abdominal pains, while others have irritability or depression with the onset of the disease.

Common symptoms are these:

  • chronic diarrhea;
  • weight loss;
  • recurring abdominal pain and bloating;
  • gas;
  • pale, foul-smelling stool;
  • unexplained anemia;
  • muscle cramps or weakness, or bone pain;
  • pain in the joints;
  • tingling numbness in the legs;
  • delayed growth;
  • fatigue;
  • painful skin rash;
  • missed menstrual periods (which is linked to excessive weight loss);
  • and tooth discoloration or loss of enamel.

Sometimes individuals with celiac disease are asymptomatic, as the undamaged part of the small intestine is still able to absorb enough nutrients. However, these persons are still at risk for complications of the disease. 


Diagnosis

Because symptoms of celiac disease are similar to those of other digestive diseases such as Crohn's disease, irritable bowel syndrome, ulcerative colitis, diverticulosis, and intestinal infections, it can be difficult to diagnose. In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose celiac disease:

  • blood work (to measure the level of antibodies to gluten). Researchers have found that persons with celiac disease have higher than normal levels of certain antibodies in their blood. These antibodies are produced by the immune system in response to substances (such as gluten) that the body perceives as threatening.
  • biopsy via upper endoscopy. 

Treatment

In addition to treatment of symptoms, treatment for celiac disease is also based on responding to and compensating for the underlying condition; that is, making dietary changes to avoid gluten and the immune reaction that it triggers. Working to achieve a gluten-free diet is the key to treatment, as there is no way to reverse the basis of the disease. Thus, for those with celiac disease, adhering to a gluten-free diet is a lifetime requirement, as eating any gluten will further damage the intestine.

For most individuals, eliminating gluten from their diet will stop symptoms, heal intestinal damage that has already occurred, and prevent further damage. Usually, a person will see an improvement in symptoms within days of starting the diet and, within three to six months, the small intestine is usually completely healed, with villi intact and working. For older persons, complete healing may take up to two years.

Persons on a gluten-free diet must avoid all foods containing wheat, rye, barley and (sometimes) oats. This includes foods containing spelt, triticale, and kamut and most grain, pasta, cereal, and processed foods. While this excludes many foods, persons with celiac disease can still enjoy a well-balanced diet, substituting foods made with potato, rice, soy, or bean flour. There are also a variety of gluten-free breads and pastas available at health food stores and through special food companies.

Scientists are still trying to determine whether persons with celiac disease can eat oats, as some people are able to without having a reaction. Until studies are more definitive, persons with celiac disease should follow their physician's or a dietitian's advice.

Plain meat, fish, rice, vegetables, and fruits do not contain gluten, so these can be eaten without worry. It is important for persons with celiac disease to be especially careful when dining out, or eating at school, work, or social functions. A gluten-free diet must be a lifetime commitment to keep celiac disease under control. Those with the condition should consult their physician, dietitian, or other healthcare professional to learn more about a gluten-free diet.