Article Revisions
Celiac disease (also called celiac sprue, nontropical sprue, and gluten-sensitive enteropathy) is an autoimmune disease affecting the digestive tract. When people with celiac disease eat food with gluten—a type of protein found in wheat, rye, barley, and oats—it provokes an immune reaction that causes flattening and damage to the small protrusions (villi) in the small intestine that absorb nutrients.
The resulting smooth surface in the lining of the intestine inhibits the ability to digest and absorb nutrients in many, if not all, foods. As a result, people with untreated celiac disease can suffer from malnutrition and a host of symptoms caused by malnutrition. Thus, celiac disease is also classified as a disease of malabsorption.
The Digestive Tract |
It is not known exactly why people with celiac disease react to gluten-containing foods in such a negative manner. If you have celiac disease, chances are that approximately 10% of your immediate family does, too. The disease can occur at any age. In some cases, symptoms of the disease do not emerge until after some form of trigger. Triggers can include an infection, pregnancy, severe stress, surgery, or physical injury. To prevent symptoms, a person with celiac disease must avoid foods containing gluten.
What are the risk factors for celiac disease?
[What are the symptoms of celiac disease?
[How is celiac disease diagnosed?
[What are the treatments for celiac disease?][6]
Are there screening tests for celiac disease?
[How can I reduce my risk of celiac disease?
Your doctor will ask about your symptoms and medical history and perform a physical exam. Because the symptoms of celiac disease are often very similar to those of other conditions, it can be difficult to obtain an accurate diagnosis early on. However, early diagnosis of celiac disease is very important because the earlier you start the gluten-free diet, the less likely you are to have advanced damage to your intestinal tract. Maintaining a gluten-free diet is very important to help prevent complications caused by celiac disease.
Your doctor may suspect celiac disease:
- In a child—if the child eats well but still shows signs of malnutrition (especially if there is a family history of the disease)
- In an adult—if you have dermatitis herpetiformis (a gluten-sensitive skin rash), gastrointestinal symptoms, evidence of iron deficiency, signs of vitamin deficiency, or a family history of the disease.
If celiac disease is suspected, tests will be done to confirm the diagnosis. Tests include:
Blood Tests—a blood sample is taken to check for:
- The presence of certain antibodies to gluten, which are produced by the immune system
- Evidence of malabsorption of nutrients, such as anemia and vitamin and mineral deficiencies
Endoscopy—a thin, lighted tube inserted down the throat to examine and biopsy the intestine
Endoscopy |
Biopsy—Performed via an endoscope to confirm the diagnosis of celiac disease. It requires the removal of a small sample of tissue from the small intestine during endoscopy to test for flattened and damaged villi. If the biopsy shows signs of celiac sprue, you may be put on a gluten-free diet for about 3-6 months. After that time, a second biopsy may be done to look for signs of improvement, such as positive changes in the villi of the small intestine.
There are no guidelines for preventing celiac disease. Ask your doctor about a screening test for you and your children if celiac disease runs in your family.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed March 9, 2006.
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
American Gastroenterological Association (AGA)
Address:
National Office
4930 Del Ray
Avenue Bethesda, MD 20814
Phone:
1-301-654-2055
Internet Address:
http://www.gastro.org
Description of Services Provided:
This site covers all gastrointestinal conditions, including celiac disease. Using the search option, you'll find the latest research news on this disease.
Celiac Disease Foundation (CDF)
Address:
13251 Ventura Blvd., Suite 1
Studio City, CA 91604-1838
Phone:
1-818-990-2354
Internet Address:
http://www.celiac.org
Description of Services Provided:
The CDF provides support, information, and assistance to people affected by celiac disease and dermatitis herpetiformis (CD/DH). The CDF also works closely with healthcare professionals and pharmaceutical and medical industries.
Celiac Sprue Association
Address:
PO Box 31700
Omaha, NE 68131-0700
Phone:
877 CSA-4-CSA (US toll free)
(402) 558-0600
Internet Address:
http://www.csaceliacs.org
Description of Services Provided:
At this site, you'll find a network of chapters, resource units, and contact persons that represent a local support system for people following the gluten-free diet. You can also read through a series of educational materials covering current information and research on celiac disease.
Canadian Celiac Association
Address:
5170 Dixie Road suite 204
Mississauga, ON L4W 1 E3
Phone:
1-800-363-7296
(905) 507-6208
Internet Address:
http://www.celiac.ca/
Description of Services Provided:
The Canadian Celiac Association is a national organization dedicated to providing services and support to persons with celiac disease and dermatitis herpetiformis through programs of awareness, advocacy, education and research.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
American Gastroenterologic Association website. Available at: http://www.gastro.org . Accessed March 9, 2006.
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Guidelines
In the United States, children are generally not screened for celiac disease. In countries where celiac disease is more common, children are routinely screened for the disease. For example, in Italy, children are screened for celiac disease by age six. The Mayo Foundation for Medical Education and Research recommends the following:
- If someone in your family is known to have celiac disease, you should be screened for it. Doing so can help avoid the complications that can result from not treating the disease.
- If you suffer from celiac disease, you should be tested for nutritional deficiencies. In some cases, testing for bone density may also be necessary.
Screening for celiac disease involves testing for the antibodies to gluten. This is done by testing a blood sample for three specific antibodies: antigliadin, anti-endomysium, and antireticulin.
There is a test available that may eventually become the test used to screen large populations. It is a blood test that detects an antigen called tissue transglutaminase (tTG).
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed March 9, 2006.
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with celiac disease. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions you may not have thought to ask.
- Write out your questions ahead of time so you don't forget them.
- Write down the answers you get, and ask for clarification if necessary.
- Don't be afraid to ask questions and to find out where you can get more information. You have a right to know.
Specific Questions to Ask Your Doctor
About Celiac Disease
- How common is it?
- How serious is it?
About Your Risk of Developing Celiac Disease
- Members of my family have celiac disease, but I’ve never had symptoms. Should I be tested?
- I have celiac disease. Should my children be tested?
- If celiac disease does not run in my family, can I still get it?
About Treatment Options
- What treatments are available if a gluten-free diet does not control all of my symptoms?
- Do you recommend medications for me?
- What benefits and side effects should I expect from medications?
About Lifestyle Changes
- Is there a chance that at some point I may be able to re-introduce some gluten-containing foods to my diet?
- Where can I buy gluten-free foods?
- Are there any alcoholic beverages that are gluten-free?
- What if I accidentally eat gluten-containing foods?
- Do I need the help of a dietitian to maintain a gluten-free diet? If so, can you refer me to one?
- What specific precautions should I take before eating at restaurants?
- How can I eat when at other people's homes, on vacation, etc?
About Outlook
- Other then maintaining a gluten-free diet, can I live a normal lifestyle?
- If I maintain a gluten-free diet, can I avoid severe complications from the disease?
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
Berkow R. The Merck Manual of Medical Information.17th ed. New York, NY: Simon and Schuster, Inc; 2000.
Collin P, Thorell L, Kaukinen K, Maki M. The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Aliment Pharmacol Ther.2004;19:1277.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed March 9, 2006.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
Rostom, A, Dube, C, Cranney, A, et al. Celiac disease. Summary, evidence report/technology assessment No 104. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
Celiac disease (also called celiac sprue, nontropical sprue, and gluten-sensitive enteropathy) is an autoimmune disease affecting the digestive tract. When people with celiac disease eat food with gluten—a type of protein found in wheat, rye, barley, and oats—it provokes an immune reaction that causes flattening and damage to the small protrusions (villi) in the small intestine that absorb nutrients.
The resulting smooth surface in the lining of the intestine inhibits the ability to digest and absorb nutrients in many, if not all, foods. As a result, people with untreated celiac disease can suffer from malnutrition and a host of symptoms caused by malnutrition. Thus, celiac disease is also classified as a disease of malabsorption.
The Digestive Tract |
It is not known exactly why people with celiac disease react to gluten-containing foods in such a negative manner. If you have celiac disease, chances are that approximately 10% of your immediate family does, too. The disease can occur at any age. In some cases, symptoms of the disease do not emerge until after some form of trigger. Triggers can include an infection, pregnancy, severe stress, surgery, or physical injury. To prevent symptoms, a person with celiac disease must avoid foods containing gluten.
What are the risk factors for celiac disease?
What are the symptoms of celiac disease?
How is celiac disease diagnosed?
What are the treatments for celiac disease?
Are there screening tests for celiac disease?
How can I reduce my risk of celiac disease?
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
American Gastroenterological Association website. Available at: http://www.gastro.org . Accessed March 9, 2006.
The Merck Manual of Medical Information,17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop celiac disease with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing celiac disease. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.
Genetic Factors
Your chances of having celiac disease are greater if the condition runs in your immediate family. It is estimated that close relatives of people with celiac disease have a 5%-10% chance of developing the disease.
Ethnic Background
Celiac disease tends to be more common in people who are of European descent.
Medical Conditions
If you have another autoimmune disorder, you are at greater risk of developing celiac disease. These disorders include:
- Lupus
- Type 1 diabetes
- Autoimmune thyroid disease
- Rheumatoid arthritis
- Dermatitis herpetiformis (a skin condition associated with celiac disease)
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed March 9, 2006.
The Merck Manual of Medical Information,17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
Symptoms of celiac disease can vary in type and/or severity. Symptoms can start as soon as gluten is introduced into the diet, or they may not develop until adulthood. Children often have different symptoms than adults. Symptoms may not develop (or may be mild) if a large section of the intestine is undamaged. Malnutrition may produce the first signs of the condition, which are often the most serious. Some people with celiac disease have no symptoms of it. Signs and symptoms may include:
- Weight loss
- Abdominal cramps, bloating, and gas
- Diarrhea
- Smelly, light-colored, oily stool
- Change in appetite
- Fatigue
- Anemia
- Bone problems, such as:
- Osteoporosis , osteopenia (thinning of the bones)
- Osteomalacia (poorly formed bones; known as rickets when due to vitamin D deficiency)
- Bone pain
- Short stature (in children)
- Reproductive system problems, such as missed menstrual periods and infertility
- Dermatological problems, such as:
- Angular cheilitis (cracked sores in the corners of the mouth)
- Skin rash, especially dermatitis herpetiformis (a gluten-sensitive skin rash)
- Aphthous ulcers (shallow sores in the mucous membranes of the mouth)
- Neuro-psychological problems, such as:
- Behavior changes
- Depression
- Irritability
- Seizures
- Neuropathy (tingling or numbness, most often in the feet or lower legs)
- Dizziness
- Muscle cramps and joint pain
- Dental problems, related to malabsorption of calcium and vitamin D
- Failure to thrive (in infants)
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/ . Accessed March 9, 2006.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed March 9, 2006.
The Merck Manual of Medical Information,17th ed. Simon and Schuster, Inc.; 2000.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Accessed March 9, 2006.
Your doctor will ask about your symptoms and medical history and perform a physical exam. Because the symptoms of celiac disease are often very similar to those of other conditions, it can be difficult to obtain an accurate diagnosis early on. However, early diagnosis of celiac disease is very important because the earlier you start the gluten-free diet, the less likely you are to have advanced damage to your intestinal tract. Maintaining a gluten-free diet is very important to help prevent complications caused by celiac disease.
Your doctor may suspect celiac disease:
- In a child—if the child eats well but still shows signs of malnutrition (especially if there is a family history of the disease)
- In an adult—if you have dermatitis herpetiformis (a gluten-sensitive skin rash), gastrointestinal symptoms, evidence of iron deficiency, signs of vitamin deficiency, or a family history of the disease.
If celiac disease is suspected, tests will be done to confirm the diagnosis. Tests include:
Blood Tests—a blood sample is taken to check for:
- The presence of certain antibodies to gluten, which are produced by the immune system
- Evidence of malabsorption of nutrients, such as anemia and vitamin and mineral deficiencies
Endoscopy—a thin, lighted tube inserted down the throat to examine and biopsy the intestine
Endoscopy |
Biopsy—Performed via an endoscope to confirm the diagnosis of celiac disease. It requires the removal of a small sample of tissue from the small intestine during endoscopy to test for flattened and damaged villi. If the biopsy shows signs of celiac sprue, you may be put on a gluten-free diet for about 3-6 months. After that time, a second biopsy may be done to look for signs of improvement, such as positive changes in the villi of the small intestine.
