Celiac Disease

Celiac disease is an autoimmune disease that causes your body to react to a protein called gluten. When you eat gluten, it triggers an abnormal response from your immune system. Your immune system attacks the gluten in your digestive system, causing inflammation. This inflammation damages the inside of your small intestine.

Your small intestine is where most of the nutrition from food gets absorbed. So, damage to this organ can prevent it from doing its job and lead to serious complications.

Without treatment, celiac disease can lead to malabsorption and malnutrition. Malnutrition has many serious side effects, especially in children. Children with celiac disease may have growth and development delays.

Gluten is found in grains like wheat, barley and rye. These grains make up many of the staple foods of the standard Western diet. These include bread, cereals, pasta and beer. Gluten is also added to many food products that you may not expect. These include sauces, soups and packaged foods.

If you have celiac disease, it’s important to eat gluten-free.

Celiac disease symptoms

Signs and symptoms of celiac disease can appear at any age. Healthcare providers most often see it develop during two clear age windows:

• Early childhood, between 8 and 12 months old (when children may begin eating solid foods with gluten in them, like crackers or cereals)
• Midlife, between the ages of 40 and 60

Celiac disease symptoms vary widely. Some people don’t notice any symptoms at all. Some experience indigestion or other GI symptoms after eating gluten. Others only begin to see signs of nutrient deficiencies later, when significant damage has been done.

Gastrointestinal (digestive) symptoms of celiac disease may include:

• Stomach pain
• Bloating
• Gas
• Diarrhea

Nondigestive symptoms may include:

• Paleness
• Extreme tiredness
• Cold hands
• Indented (concave) nails
• Dental enamel defects
• Abnormal periods
• Trouble getting pregnant
• Irritability or depression
• Unexplained weight loss
• Growth faltering in children

Some people with celiac disease develop a condition called dermatitis herpetiformis. This is an itchy rash that looks like clusters of bumps or blisters. It affects your elbows, knees, butt and scalp.

What causes celiac disease?

Almost everyone with celiac disease has a genetic change (variant) in the HLA-DQ2 gene or HLA-DQ8 gene. You get these changes from your biological parents. But not everyone with these genes develops celiac disease.

Celiac disease is partly genetic, but other factors are also involved in triggering it. Some experts think the balance of microorganisms living in your gut might play a part. Others think a major physical event, like an illness or surgery, might trigger it.

Risk factors

You’re more likely to develop celiac disease if you’re female. Your chances also increase if you have:

• Another autoimmune disease
• A chromosomal disorder, like Turner syndrome, Williams syndrome or Down syndrome
• A first-degree relative (biological parent, sibling or child) who has it

Complications of this condition

Without treatment, celiac disease can lead to long-term complications. These include:

• Malnutrition, which leads to changes in your nervous system and skeletal system that can be hard to reverse
• Food intolerances, like lactose intolerance, due to damage to your intestinal lining
• Collagenous sprue, which causes collagen deposits in the lining of your small intestine that prevent it from absorbing nutrients
• Weakened immunity, which makes you more vulnerable to illness, including other autoimmune diseases

Celiac disease may also affect your liver. Over time, you can develop chronic liver disease. Untreated celiac disease also increases your risk of developing small intestine cancer.

How is celiac disease diagnosed?

If you have celiac disease symptoms after eating gluten, you may have the condition.

Keep in mind that food intolerances can cause discomfort that mimics celiac disease. Many people have a sensitivity to gluten or wheat products.

But these conditions don’t damage your small intestine the way celiac disease does. To make a celiac disease diagnosis, your healthcare provider will look for signs of this damage.

How to test for celiac disease

Healthcare providers use two celiac disease tests. They like to use them together to confirm the diagnosis:

1. Blood test: Your provider checks your blood for antibodies to gluten.
2. Biopsy: Your provider looks for damage to the lining of your small intestine. They do an endoscopy to take a small tissue sample (biopsy).

Your provider may also want to test your blood for nutrient deficiencies. Severe deficiencies can have wide-ranging effects on your body. You may need nutrition therapy to treat them. Common findings include:

• Iron-deficiency anemia
• Vitamin-deficiency anemia
• Vitamin D deficiency

How is celiac disease treated?

The most crucial step in celiac disease treatment is to stop eating gluten. You can’t change the way your body reacts to gluten. But you can prevent gluten from triggering that reaction.

When you stop eating gluten, it allows your small intestine to begin to heal. It will soon be able to absorb nutrients again. But you need to be strict about following a gluten-free diet for life. Otherwise, gluten could hurt your small intestine again.

Other celiac disease treatments may include:

• Nutritional supplements to replace any serious deficiencies
• Medications to treat dermatitis herpetiformis, like dapsone
• Corticosteroids for severe inflammation

You’ll also need regular follow-up care, including frequent testing.

How long does the treatment take to work?

Most people say their symptoms improve almost immediately after starting to eat gluten-free. It may take several weeks to reverse your nutrient deficiencies. It may take several months for your gut lining to fully heal. It can take longer, in some cases. It depends on how damaged your gut is and how long the damage has been going on. Eating any amount of gluten (however small) can also delay healing.

What is the outlook for people with celiac disease?

Most people who stop eating gluten have an excellent prognosis. Most of the damage done by celiac disease can be undone. If you continue to have symptoms, it may be that you’re consuming small amounts of gluten without realizing it. It’s also possible you have another condition. A small percentage of people have a type of celiac disease that doesn’t respond to standard treatments.