Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.
If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine’s lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.
In children, malabsorption can affect growth and development, besides causing the symptoms seen in adults.
There’s no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.
What are the symptoms of celiac disease?
Symptoms of celiac disease vary widely, and a person may have multiple symptoms that come and go. If you have celiac disease, you may have digestive problems or other symptoms. Digestive symptoms are more common in children than in adults. Digestive symptoms of celiac disease may include
- bloating
- chronic diarrhea
- constipation
- gas
- lactose intolerance due to damage to the small intestine
- loose, greasy, bulky, and bad-smelling stools
- nausea or vomiting
- pain in the abdomen
For children with celiac disease, being unable to absorb nutrients at a time when they are so important to normal growth and development can lead to
- damage to the permanent teeth’s enamel
- delayed pubertyNIH external link
- failure to thrive, meaning that an infant or a child weighs less or is gaining less weight than expected for his or her age
- mood changes or feeling annoyed or impatient
- slowed growth and short height
- weight loss
- bloating
- chronic diarrhea
- constipation
- gas
- lactose intolerance due to damage to the small intestine
- loose, greasy, bulky, and bad-smelling stools
- nausea or vomiting
- pain in the abdomen
Depending on how old you are when a doctor diagnoses your celiac disease, some symptoms, such as short height and tooth defects, may not improve. People with celiac disease who have no symptoms can still develop complications over time if they do not get treatment.
Dermatitis herpetiformis.
Dermatitis herpetiformis is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks, back, or scalp. Among people with untreated celiac disease, about 2 to 3 percent of children and 10 to 20 percent of adults have dermatitis herpetiformis.3 Some people with celiac disease may have the rash and no other symptoms. After a person starts a gluten-free diet, the rash may take some time to heal and may return if a person consumes small amounts of gluten.
What causes celiac disease?
Research suggests that celiac disease only occurs in people who have certain genes and eat food that contains gluten. Experts are studying other factors that may play a role in causing the disease.
Genes
Celiac disease almost always occurs in people who have one of two groups of normal gene variantsNIH external link, called DQ2 and DQ8. People who do not have these gene variants are very unlikely to develop celiac disease. About 30 percent of people have DQ2 or DQ8. However, only about 3 percent of people with DQ2 or DQ8 develop celiac disease.4
Researchers are studying other genes that may increase the chance of developing celiac disease in people who have DQ2 or DQ8.
Diagnosis.
A doctor can often diagnose celiac disease by considering the medical histories of the person and their family and ordering tests such as blood tests, genetic tests, and biopsies.
Doctors check the blood for the presence of antibodies common in people with celiac disease, including antigliadin and endomysial antibodies.
If other tests indicate celiac disease, a doctor may perform an intestinal biopsy by using an endoscope to take samples of the intestinal lining. Usually, they take several to increase the accuracy of the findings.
Celiac disease can be difficult to diagnose because it shares symptoms with other conditions, including:
- irritable bowel syndrome
- Crohn’s disease of the small intestine
- lactose intolerance
- non-celiac gluten sensitivity
- small intestinal bacterial overgrowth
- pancreatic insufficiency.
Diet.
For most people with celiac disease, switching to a gluten-free dietgreatly improves the symptoms, and a person may notice improvement in days or weeks.
In children, the small intestine usually heals in 3–6 monthsTrusted Source. In adults, full healing can take several years. Once the intestine heals, the body is able to properly absorb nutrients from food again.
Having a gluten-free diet is easier than ever in some parts of the world, where gluten-free options are becoming more widely available.
The key is to understand which foods and products such as toothpaste tend to contain gluten. A qualified dietitian can help.
What to eat and avoid
Gluten occurs naturally in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, contain gluten. Beers and other grain-based alcoholic drinks can also contain it.
It is crucial to check labeling because gluten can be an ingredient in some unexpected products.
Foods that do not contain gluten include:
- meat and fish
- fruits and vegetables
- some grains, including rice, amaranth, quinoa, and buckwheat
- rice flour
- cereals such as corn, millet, sorghum, and teff
- pasta, bread, baked goods, and other products labeled “gluten-free”
A person can also eliminate gluten from recipes by substituting ingredients and sometimes by adjusting the time and temperature of baking.
In the past, experts recommended that people with celiac disease avoid oats. However, evidenceTrusted Sourcenow suggests that moderate amounts of oats are generally safe, provided that the oats have not touched gluten during processing.
According to the Food and Drug Administration (FDA)Trusted Source, manufacturers must not label a food product as gluten-free unless it contains less than 20 parts per million of gluten — the lowest level that tests can reliably detect.
It is worth keeping in mind while traveling that regulations about labeling vary from country to country.
Many processed foods can contain gluten, including:
- canned soups
- salad dressings
- ketchup
- mustard
- soy sauce
- seasonings
- ice cream
- candy bars
- processed and canned meats and sausages
Nonfood products can also contain gluten, including:
- some prescription and over-the-counter medications
- vitaminproducts
- toothpaste
- cosmetics, including lipstick, lip gloss, and lip balm
- postage stamps
- communion wafers
