What Is Celiac Disease?

Celiac disease is an abnormal immune reaction in the small intestine to gluten — a protein found in wheat, rye, and barley. 

People with celiac disease have higher than normal levels of antibodies, or infection-fighting cells, that attack gluten. When someone with celiac disease ingests gluten, their body views the gluten as a foreign invader. The body then initiates a response in the small intestine, limiting the nutrients a person absorbs from their food. 

Celiac disease is genetic, and as many as 1 in 133 Americans may have the condition. There’s no cure for celiac disease, but people must understand its symptoms so they can seek a diagnosis and guidance from their doctor on living with the condition. 

Types of Celiac Disease

There are two types of celiac disease: nonresponsive celiac disease and refractory celiac disease. 

Nonresponsive celiac disease

This term is used for celiac disease that doesn’t respond to dietary changes made to eliminate gluten. However, in some instances, supposedly gluten-free foods are contaminated with the protein, causing ongoing symptoms. Patients can work with a dietician to ensure they ingest no gluten.

Refractory celiac disease

This celiac disease type is characterized by a lack of response to a gluten-free diet for more than six months. Patients with refractory celiac disease may need additional testing to determine if there are other causes for their symptoms. 

Signs & Symptoms

Celiac disease shares symptoms with many other chronic digestive issues, including Crohn’s disease, irritable bowel syndrome, colitis, and diverticulitis.

Celiac Disease Symptoms in Adults

Some common symptoms of celiac disease in adults include:

• Unexplained weight loss
• Persistent flatulence
• Chronic diarrhea or constipation
• Stomach and muscle cramps
• Joint pain
• Anemia
• Missed periods
• Infertility
• Numbness and tingling in the legs
• Painful, itchy skin rash
• Weak bones
• Tooth enamel loss

Some people who have celiac disease may have no symptoms at all.

Celiac Symptoms in Children

Infants and young children are likely to experience digestive problems like abdominal bloating and pain, gas, and foul-smelling stools. Additional symptoms can include the following:

• Chronic diarrhea, which can be bloody
• Constipation
• Vomiting
• Fatigue
• Irritability
• Neurological symptoms including learning disabilities, ADHD, headaches, lack of muscle coordination, and seizures
• Tooth enamel damage
• Anemia
• Growth problems that include not growing as expected or short stature
• Weight loss

Causes

The exact causes of celiac disease are unknown. However, doctors believe several factors may contribute to developing or activating the disease, including:

• Genetics
• Eating foods containing gluten
• Infant-feeding practices
• Intestinal tract infections
• Gut bacteria
• Pregnancy
• Childbirth
• Surgery
• Viral infection
• Significant emotional stress

When celiac disease develops and the immune system overreacts to gluten, the response damages hairlike structures called villi lining the small intestine. Villi absorb nutrients from food. When they’re damaged, someone with celiac disease can’t get the nutrients they need.

Risk Factors

Some people are at a higher risk of celiac disease and gluten sensitivity, including:

• People with European ancestors
• Caucasians
• People with type 1 diabetes
• People with Down Syndrome
• People with autoimmune disorders
• People who are infertile
• People who are pregnant
• People with irritable bowel syndrome

Diagnosis

It’s common for people to be unaware that they have celiac disease. They may have a vague sense that certain foods don’t agree with them but have never connected that fact with the disease. 

However, if you report symptoms that align with celiac disease, your doctor can order testing for celiac disease. Two types of celiac disease tests are used: blood tests and biopsy tests. 

Blood tests

• Serology tests for celiac disease detect specific antibodies that, if elevated, indicate an immune reaction to gluten. 
• Genetic testing focuses on human leukocyte antigens (HLA-DQ2 and HLA-DQ8) that can rule out celiac disease.

Biopsy tests

Biopsy testing is done through a process called endoscopy, in which your doctor puts a long tube with a tiny camera down your throat. It enables them to see inside your small intestine and take a small tissue sample that can be examined for signs of damage to the villi. 

Information from these two types of tests enables your doctor to make a celiac disease diagnosis. 

Prevention

Celiac disease prevention is focused on avoiding symptoms. While you can’t avoid the disease itself, you can minimize your exposure to gluten to prevent symptoms and damage to your small intestine. 

Success requires avoiding all foods containing wheat, barley, and rye, including foods manufactured in facilities where cross-contamination can occur. You should also avoid drinking milk or consuming products containing it for a period after your celiac diagnosis to give your small intestine time to heal. 

Keep in mind that gluten may be present in unexpected places, like toothpaste, mouthwash, lipstick, and the gummy material used to seal envelopes. 

Treatment

The only effective celiac disease treatment is strict avoidance of foods containing gluten. A dietician can help you create a completely gluten-free diet. It’s important not to consume any gluten since even amounts so small that they don’t produce symptoms can damage your small intestine. 

Diet

As noted above, your doctor will likely suggest removing gluten entirely from your diet. You may find this rather difficult, as gluten is present in many foods in the Western diet. Once you stop eating foods containing gluten, you may notice your symptoms clear up in as little as three days. The earlier celiac disease is caught and treated (by removing all sources of gluten from the diet), the less time healing takes. Generally, in children, full healing is seen within six months. Adults may require one to two years to see full healing, and those with advanced symptoms may take even longer or may never fully recover.

Eliminating gluten can be tricky because gluten can be listed on nutrition labels under many names and present in foods you wouldn’t immediately suspect. Many people trying a gluten-free diet are advised to avoid wheat, barley, and rye but are unaware that many processed foods are made with gluten-containing ingredients. Pay special attention to nutrition labels and look out for “hidden gluten” that may be listed as caramel color, spelt, wheat starch, wheat bran, hydrolyzed wheat protein, dextrin, or mono- and di-glycerides.

Gluten often “hides” in many of the below foods:

• Beer, ale, and lagers
• Bouillon cubes
• Brown rice syrup
• Candy
• Chips, potato chips
• Cold cuts, hot dogs, salami, and sausage
• Corn flakes and crisp rice cereal
• Communion wafers
• French fries
• Gravy
• Imitation fish
• Matzo
• Pickles
• Rice mixes
• Sauces and salad dressings
• Seasoned tortilla chips
• Self-basting turkey
• Soups
• Soy sauce
• Taco seasoning packets
• Vegetables in sauce
• Vinegar

Vitamins and supplements

If you have anemia or nutritional deficiencies from celiac disease, your doctor may have you take supplements, including: 

• Copper
• Iron
• Vitamin B-12
• Zinc
• Vitamin D
• Folate
• Vitamin K

Typically, you consume these in pill form. However, if damage to your digestive system makes it hard to absorb these supplements, your doctor may give them by injection. 

Prognosis

If you stop consuming gluten after being diagnosed, your celiac disease prognosis is likely excellent. The body can typically repair most of the damage done by the disease. 

If you continue to have symptoms, you’re likely unaware that something you’re eating contains gluten. Refractory celiac (the type that doesn’t respond to dietary changes) is rare, affecting just 5% of people with the disease.

Complications

When people with celiac disease eat foods containing gluten, their immune system attacks the lining of their small intestine, causing damage that prevents the absorption of nutrients. This can lead to celiac disease complications, such as:

• Malnutrition and other issues stemming from it
• Bone weakening from osteoporosis
• Infertility and miscarriage, which are challenging for those trying to start or expand their family
• Lactose intolerance when the body can’t properly break down lactose
• Increased risk of cancer in the small intestine and esophagus 
• Nervous system problems, including tingling and numbness, balance problems, and muscle spasms
  
  

Get Help from Baptist Health

Celiac disease can feel debilitating if left untreated, but help is available. Learn more about the digestive services and treatments available at Baptist Health, or speak with your healthcare provider about your symptoms. If you don’t have a healthcare provider, you can find a Baptist Health provider near you via our online provider directory.