What is Celiac Disease?
Celiac disease is a chronic condition mainly affecting the small intestine. It is a permanent sensitivity to gluten, a protein from wheat, rye, and barley. In those affected, eating food with gluten leads to damage to the finger-like projections, or villi, lining the small intestine. Other names include celiac sprue and gluten sensitive enteropathy. Celiac disease is considered an auto-immune disorder, in which the body attacks itself.
A person with celiac disease may have no symptoms or any of the following:
- Recurring abdominal pain and bloating
- Chronic diarrhea
- Pale, foul-smelling, or fatty stool
- Weight loss/weight gain
- Unexplained anemia
- Bone or joint pain
- Osteoporosis, osteopenia
- Behavioral changes
- Tingling numbness in the legs (from nerve damage)
- Muscle cramps
- Missed menstrual periods (often because of excessive weight loss)
- Infertility, recurrent miscarriage
- Delayed growth
- Failure to thrive in infants
- Pale sores inside the mouth, called aphthous ulcers
- Tooth discoloration or loss of enamel
- Itchy skin rash
Diagnosis of celiac disease can be difficult because some of its symptoms are similar to those of other diseases. It can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed. Recently, researchers discovered that people with celiac disease have higher than normal levels of certain autoantibodies in their blood. Autoantibodies are proteins that react against the body’s own molecules or tissues. To diagnose celiac disease, physicians will usually test blood to measure levels of
- Immunoglobulin A (IgA)
- anti-tissue transglutaminase (tTGA)
- IgA anti-endomysium antibodies (AEA)
If the tests and symptoms suggest celiac disease, the doctor will perform a small bowel biopsy. During the biopsy, the doctor removes a tiny piece of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, the doctor eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine. Using instruments passed through the endoscope, the doctor then takes the sample.
The only treatment for celiac disease is to follow a gluten-free diet. When a person is first diagnosed with celiac disease, the doctor usually will ask the person to work with a dietitian on a gluten-free diet plan. A dietitian is a health care professional who specializes in food and nutrition. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.
For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet. The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults.