Celiac disease (also known as celiac sprue or gluten-sensitive enteropathy) is a complex disorder stemming from an autoimmune reaction in the body when someone ingests gluten, a protein found in wheat, barley and rye. As a result, their small intestine is damaged, and their body can’t properly absorb nutrients from food.
The difference between celiac disease and a gluten sensitivity, sometimes referred to as non-celiac gluten sensitivity (NCGS), is that patients suffering from celiac disease will have:
- Damage to their intestine.
- Specific markers in the blood.
- Symptoms that may not improve after following a diet without gluten.
Most people who are diagnosed with celiac disease are adults, but evidence suggests you can develop it any age. Patients with celiac disease have many symptoms including diarrhea, weight loss, abdominal pain, and numerous other concerns. There is no one issue that is specific to celiac disease. It is a common problem found in about 1% of the population.
Why Choose Cleveland Clinic for Celiac Care?
The mission of our Celiac Disease Program is to promote excellence in clinical care and research in celiac disease and other gluten-related and small bowel disorders.
Our integrated multidisciplinary team of expert dietitians and gastroenterologists provide high quality, compassionate and individualized care for our patients, including advanced screening and diagnosis.
They will work with you to develop a treatment plan, including consultations with Cleveland Clinic dietitians to help you follow a gluten-free diet, additional screening for bone disease, immunizations and more.
Other providers at Cleveland Clinic that we work with include neurology, hematology, dermatology, rheumatology and allergy specialists. This allows us to treat every aspect of the disease and how it can affect your body.
What We Treat
At Cleveland Clinic, our celiac specialists treat a multitude of symptoms related to celiac disease, as well as:
- Gluten-related disorders.
- Enteropathy (Seronegative villous atrophy).
Diagnosis and Screening
The diagnosis of celiac disease can be suggested by blood tests that can show abnormal antibody levels. There are also blood tests available that can show if you have the genes that are associated with the genetic susceptibility for developing celiac disease.
When people with celiac disease eat foods that contain gluten, their immune systems attack the lining of the intestine. This causes inflammation (swelling) in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. Nutrients from food are absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients and ends up malnourished, no matter how much they eat.
Your provider may take a biopsy from your small intestine to check for damage to the villi. In a biopsy, the doctor inserts an endoscope (a thin, hollow tube) through your mouth and into the small intestine and takes a sample of the small intestine with an instrument. This is done with sedation or anesthesia to avoid any discomfort during the procedure.
Celiac disease tends to run in families. Studies have found that people with a relative — especially a parent, sibling or child — who has celiac disease are at an elevated risk of developing the disease themselves. Since they might not have the classic symptoms associated with it, or even have any symptoms at all, celiac disease should be actively screened if you have a first degree family member affected (parent, sibling or child).
Establishing a gluten-free diet
Our expert celiac dietitians will educate you on why and how to follow a gluten-free diet.
Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. However, the villi usually require months to years to complete healing. It might take two to three years for the intestines to heal in an adult, compared to about six months for a child.
Additional testing and immunizations
Our team also offers screening and treatment of nutritional deficiencies, as well as bone disease (osteomalacia, osteopenia or osteoporosis).
Since celiac disease is an autoimmune disorder, our team will check your immunity to vaccines (e.g. hepatitis B vaccine) and your vaccination record.
Additional testing and treatment may be necessary for refractory celiac disease, which occurs when your small intestine does not heal despite removing gluten from your diet.
What to Expect
At your first appointment, our team will gather information to perform a physical examination. You can also expect to undergo a blood test as part of your evaluation.
If your blood test comes back positive, the next step is an upper GI endoscopy and small bowel biopsy within 1 or 2 weeks of the initial evaluation. During your endoscopy, your doctor will use a long, thin, flexible instrument to examine the inside of the upper digestive system for symptoms of celiac disease. The biopsy will require your doctor to remove a portion of the lining of your small bowel for examination. If you have small bowel biopsies performed elsewhere, our team would likely request that it is reviewed by a GI pathologist at Cleveland Clinic. We would also like to review your lab testing that was done for celiac disease in addition to the small intestine biopsy. Please bring any lab studies and upper endoscopy reports with your pathology results.
Once the diagnosis has been confirmed, you will meet with a celiac dietitian to discuss establishing a gluten-free diet.
You will need regular follow-up appointments during the first year of your diagnosis, starting at 3 months, and again at 6 months and 12 months. After your disease is under control, you can begin to schedule semi-annual or annual visits with your gastroenterologist and dietitian.
The upper GI endoscopy with a small bowel biopsy need to be repeated about 2 years after starting the gluten-free diet to confirm healing of the intestinal injury.
Meet Our Team
David Gardinier, RD
Kendra Weekley, RD
Nurse/Care Program Coordinator
- Emily Trommer, RN
- Katrina Richardson, RN
- Jennifer Welsh
Endocrinologist/Calcium and Bone Specialist
Advanced Nutritional Support
Celiac Program Interest Group
This multidisciplinary team meets every 2 months for research, clinical case presentations, and group discussions. These sessions include medicine residents and gastroenterology fellows with an interest in celiac disease and the small intestine.
Appointments & Location
If you would like to make an appointment with one of our celiac experts, please call 216.444.7000.
Our office is located at Cleveland Clinic's main campus:
A Building - Crile Building
2049 East 100th Street
Cleveland, OH 44195
Celiac Disease Guidelines from American College of Gastroenterology
- Read this in-depth article on care for celiac disease patients written by Dr. Rubio-Tapia, a leading expert in the field and Director of Cleveland Clinic's program.
Get helpful information on celiac disease from our Health Essentials experts.
Butts & Guts podcast
Listen to this episode of Butts & Guts, as Dr. Alberto Rubio Tapia shares insight into celiac disease and provides recommendations for managing it on a daily basis.
Find helpful posts from Cleveland Clinic's site for physicians and healthcare professionals. Discover the latest celiac research insights, innovations, treatment trends and more: