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Celiac disease is a problem some people have with foods that contain gluten. Gluten is a type of protein. It's found in the grains wheat, barley, rye, and triticale (a wheat-rye cross).
People can have a food intolerance to gluten but not have celiac disease. Gluten sensitivity may cause similar symptoms but does not cause the same changes in the body or have the complications that celiac disease does.
When you have celiac disease and you eat food with gluten in it, the gluten triggers an immune response that is not normal. This damages the inside of your small intestine so that it can't do a good job of absorbing nutrients from your food.
It's important to get treatment, because celiac disease can:
In children, celiac disease can slow growth and weaken bones. If it isn't treated, your child can get very sick. Call a doctor if your child is losing a lot of weight, has diarrhea, or feels weak and tired for many days for no reason.
Doctors don't really know what causes the disease. Having certain genes can increase your chance of getting it. You're more likely to have these genes and get celiac disease if a close family member has the disease.
Symptoms of celiac disease include:
These symptoms can be very mild.
Some people vomit after they eat gluten. This is more likely to happen in children than in adults.
Your doctor will ask questions about your symptoms and do a physical examination.
You may have blood tests to see if you have certain antibodies that could mean you have the disease.
To make sure you have celiac disease, you will probably have an endoscopy. In this test, a doctor uses a thin, lighted tube to look at the inside of your small intestine. Your doctor can also take small samples of tissue to be tested in a lab. This is called a biopsy.
Often celiac disease is mistaken for another problem such as food intolerance or irritable bowel syndrome. You may be treated for one of these problems first.
After your celiac disease diagnosis, your doctor may do more tests, such as blood tests to check for anemia. You may also have a bone density examination. These tests will help your doctor find out if you have other problems, such as osteoporosis, that can arise when you have celiac disease.
To get and stay well, you need to avoid all foods that have gluten. For many people, this means changing everything about the way they eat. This can be challenging. For help, work with a dietitian who has experience with gluten-free diets. Together you can find foods you like that don't have gluten.
Avoid all foods made with wheat, rye, barley, or triticale. Don't drink any beer or ale.
You can still eat eggs, meat, fish, fruit, and vegetables. Flours and foods made with amaranth, arrowroot, beans, buckwheat, corn, cornmeal, flax, millet, potatoes, pure uncontaminated nut and oat bran, quinoa, rice, sorghum, soybeans, tapioca, or teff are also okay. Within 2 weeks after starting a gluten-free eating plan, most people find that their symptoms start to get better.
For a short time after your treatment starts, you might also need to stop drinking cow's milk and foods made with it. Most of the time, but not always, people can have these foods again after their intestine has healed.
Some foods that are labelled "wheat-free" may still have gluten. Gluten can be in things you may not expect, like medicine, vitamins, and lipstick. Be sure to read labels.
Watch out for the following phrases. They could mean that a product contains gluten:
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Although the exact cause of celiac disease isn't known, having certain genes increases your risk. You are more likely to have these genes if you have a first-degree relative (mother, father, brother, sister, son, or daughter) who has celiac disease.
Environmental factors, such as infections, may trigger changes in the small intestine of a person with these genes. Then, eating foods that contain gluten can trigger an abnormal immune system response. Over time, this response can cause digestion and absorption problems.
Symptoms of celiac disease vary widely and may come and go. They may be very mild and go completely unnoticed, or they may be severe and impact daily life.
If not treated, celiac disease can lead to other problems. You may have problems with memory and concentration. Children may be more irritable.
Symptoms of celiac disease also occur with some other conditions.
Celiac disease is a lifelong (chronic) condition that occurs when gluten triggers an abnormal immune system response that damages the small intestine.
Your small intestine is lined with tiny, finger-shaped tissues called villi. The villi create a large surface that absorbs vitamins, sugars, and other nutrients as food passes through the small intestine. When a person who has celiac disease eats gluten, the villi flatten out and the intestinal lining becomes damaged. This decreases the area that can absorb nutrients.
In some cases, this inability to absorb nutrients may be bad enough to stunt growth and weaken bones. The loss of vitamins and minerals may lead to other problems, such as anemia, osteoporosis, or growth delays in children.
People who have celiac disease may have periods when their symptoms seem worse. Or symptoms may sometimes not be noticed at all. In adults, symptoms may occur at any age but most commonly occur during the 20s, 30s, and 40s.
Sometimes a person who has celiac disease doesn't have symptoms after eating foods that contain gluten. But damage to the small intestine is still occurring.
Within 2 weeks after starting a gluten-free diet, most people with celiac disease find that their symptoms improve. Symptoms should completely disappear within 3 months. But it takes up to 6 months or longer on a gluten-free diet for the villi to return to normal.
Staying on a gluten-free diet usually keeps symptoms from returning and lowers the risk for complications.
In rare cases, a gluten-free diet doesn't help. Some people get better for a while, but their symptoms come back even though they are still eating a gluten-free diet. This condition is called refractory sprue.
In these cases, corticosteroids or other medicines that change the immune system response may be used to control symptoms. People who do not improve on a gluten-free diet should be tested for other conditions.
In some children, symptoms begin shortly after cereal is introduced into the diet, usually after 6 months of age.
Symptoms of the disease are controlled by adopting a gluten-free diet. But a child needs to be watched for:
Children who have untreated celiac disease can become very ill. They may need to go to the hospital for treatment with fluids and medicine to restore nutrients. These treatments are usually short-term. Most children recover completely.
The risk for celiac disease may run in the family. If a close relative (parent, child, or sibling) has it, your chances of having it are higher.
When a person has inherited this risk, an infection or something else in the environment can trigger changes in the small intestine and cause celiac disease.
Also, celiac disease is more common in people who have:
Call a doctor if you or your child has symptoms of celiac disease, such as:
If you or your child has been diagnosed with celiac disease, call a doctor if:
If you think that you or your child may have celiac disease, watchful waiting is appropriate if mild symptoms of diarrhea or vomiting last only for a few days. Talk with a doctor if your child continues to have diarrhea and doesn't seem to be gaining weight as expected even though he or she has a good appetite.
Your family doctor, general practitioner, or your child's pediatrician can evaluate symptoms of celiac disease.
You may be referred to a doctor who specializes in problems with the digestive system (gastroenterologist) to confirm the diagnosis with a small intestine biopsy. In addition, a dietitian can help you plan and stay on a gluten-free diet.
A medical history, physical examination, and lab tests often point to celiac disease. The diagnosis is confirmed with a small intestine biopsy collected during an endoscopy, where a small tube is guided down a person's throat to the small intestine.
Tests for celiac disease should be done when you or your child is still eating a diet that includes gluten. If you have already started a gluten-free diet before these tests are done, the doctor may suggest that you or your child eat a certain amount of gluten before the tests.
Celiac disease triggers the immune system to produce certain antibodies. Blood tests that find and measure these antibodies include:
If the results of these tests are unclear, other antibody tests may be done.
A biopsy taken during an upper gastrointestinal endoscopy may be done to confirm celiac disease after antibodies have been found. Sometimes a biopsy detects celiac disease when a person is being tested for another condition.
If the biopsy shows signs of celiac disease (such as abnormal villi and inflammation in the small intestine), a gluten-free diet will be recommended.
A diagnosis of celiac disease is confirmed if the diet makes symptoms go away and if antibody tests become normal.
Other tests that may be done include:
Tests to look for other conditions and diseases may be needed if a diagnosis of celiac disease is suspected but symptoms don't improve with a gluten-free diet.
You can prepare your child for these tests. Knowing why tests are being done and what to expect can help make the tests less scary.
The treatment for celiac disease is a gluten-free diet. Eating even the smallest amount of gluten can cause symptoms such as weight loss and diarrhea.
A gluten-free diet means:
You may also be advised to temporarily avoid milk or milk products until your intestine heals. Then you may be able to gradually reintroduce them.
For more information about following a gluten-free diet, see Home Treatment.
If you have nutritional deficiencies, you may need other treatments, such as vitamin, iron, and calcium supplements.
Treatment for complications varies depending on the specific problems and their severity. For example, some adults may require long-term treatment for complications, such as osteoporosis.
If it seems that you or your child is not getting better, you may need:
Celiac disease can't be prevented.
If you already have celiac disease, you can prevent symptoms—and damage to your small intestine—by eating a gluten-free diet.
Some adults with celiac disease have a poorly functioning or nonfunctional spleen, which is a risk factor for developing a pneumococcal infection. For this reason, your doctor may recommend that you get immunized with the pneumococcal vaccine.
Having celiac disease means that you will need to follow a gluten-free diet for the rest of your life. This can be hard to face, especially if you don't have symptoms.
With time and effort, you'll be able to change your eating habits and stay healthy. These tips may help:
Following a special diet may be especially hard for children and teens, who often don't want to feel different from their friends. Also, teens seem to have fewer symptoms than younger children after eating gluten.
Here are some things you can do to help:
If symptoms of celiac disease return after your child or you were symptom-free while following a gluten-free diet, it usually means that foods containing gluten were eaten. Here are some tips:
Call your doctor if you are confident that your or your child's diet is gluten-free but symptoms have returned or continue.
Medicine is only needed if you or your child becomes seriously ill with celiac disease or if complications develop. Some complications, such as delayed growth, can't be treated with medicine.
Your doctor may recommend taking a vitamin supplement to make sure you get enough vitamins and minerals.
If other possible illnesses have been ruled out, steroids or other medicines that change the immune system response may be used to treat refractory sprue that doesn't respond to a gluten-free diet.
Speaking with a counsellor, a psychologist, or a psychiatrist may help you cope with celiac disease by changing certain thoughts, feelings, or behaviours.
Nutritional counselling from a registered dietitian who is familiar with celiac disease can help you create a practical and healthy gluten-free diet.
CitationsLebwohl B, et al. (2013). Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: A population-based cohort study. Annals of Internal Medicine, 159(3): 169–175.Other Works ConsultedAgency for Healthcare Research and Quality (2004). Celiac Disease AHRQ Evidence Report/Technology Assessment (No. 104). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/epcsums/celiacsum.pdf.Case S (2005). The gluten-free diet: How to provide effective education and resources. Gastroenterology, 128(4, Suppl 1): S128–S134.Dewar DH, Ciclitira PJ (2005). Clinical features and diagnosis of celiac disease. Gastroenterology, 128(4, Suppl 1): S19–S24.Farrell RJ, Kelly CP (2010). Celiac disease and refractory celiac disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1797–1820. Philadelphia: Saunders.Gluten-free drugs for celiac disease patients (2008). Medical Letter on Drugs and Therapeutics, 50(1281): 19–20. Green PHR, Cellier C (2007). Celiac disease. New England Journal of Medicine, 357(17): 1731–1743.Haboubi NY, et al. (2006). Coeliac disease and oats: A systematic review. Postgraduate Medical Journal, 82(972): 672–678.Hill ID, et al. (2005). Guideline for the diagnosis and treatment of celiac disease in children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 40(1): 1–19.
Current as ofNovember 7, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineBrian O'Brien, MD, FRCPC - Internal MedicineKathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineJerry S. Trier, MD - Gastroenterology
Current as of: November 7, 2018
Author: Healthwise Staff
Medical Review:E. Gregory Thompson, MD - Internal Medicine & Brian O'Brien, MD, FRCPC - Internal Medicine & Kathleen Romito, MD - Family Medicine & Adam Husney, MD - Family Medicine & Jerry S. Trier, MD - Gastroenterology
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