Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Celiac Disease

(Celiac Sprue; Nontropical Sprue; Gluten-Sensitive Enteropathy)
by Debra Wood, RN
Definition

Celiac is an autoimmune disease of the digestive tract. With Celiac, eating food with gluten damages little protrusions in the small intestine. These protrusions, called villi, absorb nutrients from foods. The condition affects absorption of all nutrients. Untreated patients often become malnourished.

Causes

Doctors do not fully understand what causes celiac disease. Eating gluten seems to be involved. There is most likely a genetic factor. Patients with specific genes develop the disease after exposure to gluten. There is some evidence that earlier exposure in infancy causes more severe disease than later exposure.

Risk Factors

These factors increase your chance of having celiac disease.

  • History of another autoimmune disease, such as:
  • Dermatitis herpetiformis—a skin condition associated with celiac disease
  • Family members with celiac disease
  • Rheumatoid arthritis
Symptoms

Symptoms vary and may start in childhood or adulthood. Children often have different symptoms than adults. Symptoms may not develop if a large section of the intestine is undamaged. Malnutrition may produce the first signs of the condition, which are often the most serious.

Signs and symptoms may include:

In Children
In Adults
  • Abdominal pain
  • Altered sensation in the limbs
  • Anemia
  • Behavior changes
  • Bloating
  • Bone pain
  • Dental problems
  • Diarrhea
  • Dizziness
  • Fatigue
  • Foul-smelling, light-colored, oily stool
  • Gas
  • Hearty or a poor appetite
  • Infertility
  • Missed menstrual periods
  • Muscle cramps and joint pain
  • Osteopenia
  • Seizures
  • Skin rash
  • Weight loss
Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Symptoms are similar to those of other conditions. It may take a long time to get a diagnosis. Early diagnosis and treatment reduce the risk of complications.

Tests may include:

  • Biopsy —removal of a small sample of tissue during endoscopy to test for inflammation and tissue damage
  • Blood tests—to detect the presence of gluten antibodies (produced by the immune system) and look for evidence of malabsorption (anemia, vitamin and mineral deficiencies)
  • Endoscopy—a thin, lighted tube inserted down the throat to examine the intestine
  • Repeat biopsy—a biopsy performed several weeks after treatment begins to confirm the diagnosis
  • Stool tests—to check for evidence of malabsorption
Treatment

A life-long, gluten-free diet is the only treatment for celiac disease. Fortunately, it is very effective. Symptoms usually go away within days of starting the diet. Healing of the villi may take months or years. Additional intake of gluten can damage the intestine, even if you have no symptoms. Delayed growth and tooth discoloration may be permanent. Nutritional supplements, given through a vein, may be needed if the intestinal damage is significant and does not heal. Since gluten is added to many foods, the diet can be complicated and often frustrating. Some patients find support groups helpful.

Dietary Changes

You must avoid all foods containing:

  • Barley
  • Rye
  • Wheat

This includes most bread, pasta, cereal, and processed foods. Special gluten-free breads and pastas are available. They are made with potato, rice, soy, or bean flour. Patients who are lactose intolerant before their small intestine heals need to avoid milk products. A dietitian can assist you with meal planning.

Gluten is found in some unexpected foods and beverages. Carefully read all labels. Other foods with gluten include:

  • Beer
  • Commercially prepared vegetables, salads, and salad dressings
  • Creamed vegetables
  • Flavored coffee
  • Many other products
  • Packaged rice mixes
  • Pudding
  • Some frozen potatoes
  • Some ice cream
  • Tuna in vegetable broth

Ordering at restaurants can be especially challenging, since many foods on the menu may surprisingly contain gluten.

Screening and Supplements

Patients with celiac disease should be tested for nutritional deficiencies. Bone density testing may also be needed. If vitamin or mineral deficiencies are found, the doctor may recommend taking supplements. Once the disease is under control with a gluten-free diet, however, this is often not necessary.

Prevention

There are no guidelines for preventing celiac disease because the cause is not understood. If celiac disease runs in your family, ask your doctor about a screening test. The earlier you start the gluten-free diet, the less damage there will be to the intestine.

Last reviewed: September 2011 by Daus Mahnke, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
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  • Celiac disease: what you should know. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20061201/1921ph.html . Accessed July 8, 2008.
  • Conn H, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA:WB Saunders Company;2001.
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  • What I need to know about Celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac_ez/ . Accessed July 8, 2008.