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.
Your small intestine is lined with tiny hair-like projections called villi, which work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease damages the villi, leaving your body unable to absorb nutrients necessary for health and growth.
The signs and symptoms of celiac disease can vary greatly and differ in children and adults. Digestive signs and symptoms for adults include:
However, more than half the adults with celiac disease have signs and symptoms unrelated to the digestive system, including:
Children with celiac disease are more likely than adults to have digestive problems, including:
The inability to absorb nutrients might result in:
Gluten intolerance can cause this itchy, blistering skin disease. The rash usually occurs on the elbows, knees, torso, scalp and buttocks. This condition is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the skin condition might not cause digestive symptoms.
Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.
Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Consult your child's doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools.
Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you're tested for celiac disease, you can change the test results.
Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.
Your genes combined with eating foods with gluten and other factors can contribute to celiac disease, but the precise cause isn't known. Infant-feeding practices, gastrointestinal infections and gut bacteria might contribute, as well. Sometimes celiac disease becomes active after surgery, pregnancy, childbirth, viral infection or severe emotional stress.
When the body's immune system overreacts to gluten in food, the reaction damages the tiny, hairlike projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can't get enough nutrients, no matter how much you eat.
Celiac disease tends to be more common in people who have:
Untreated, celiac disease can cause:
Some people with celiac disease don't respond to what they consider to be a gluten-free diet. Nonresponsive celiac disease is often due to contamination of the diet with gluten. Working with a dietitian can help you learn how to avoid all gluten.
People with nonresponsive celiac disease might have:
In rare instances, the intestinal injury of celiac disease doesn't respond to a strict gluten-free diet. This is known as refractory celiac disease. If you still have signs and symptoms after following a gluten-free diet for six months to one year, you might need further testing to look for other explanations for your symptoms.
Many people with celiac disease don't know they have it. Two blood tests can help diagnose it:
It's important to be tested for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet might make the results of blood tests appear normal.
If the results of these tests indicate celiac disease, your doctor will likely order one of the following tests:
If your doctor suspects you have dermatitis herpetiformis, he or she might take a small sample of skin tissue to examine under a microscope (skin biopsy).
An endoscopy procedure involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum).
During a capsule endoscopy procedure, you swallow a tiny camera that's about the size of a large vitamin pill. The capsule contains lights to illuminate your digestive system, a camera to take images and an antenna that sends those images to a recorder you wear on a belt.
A strict, lifelong gluten-free diet is the only way to manage celiac disease. Besides wheat, foods that contain gluten include:
A dietitian who works with people with celiac disease can help you plan a healthy gluten-free diet. Even trace amounts of gluten in your diet can be damaging, even if they don't cause signs or symptoms.
Gluten can be hidden in foods, medications and nonfood products, including:
Removing gluten from your diet will gradually reduce inflammation in your small intestine, causing you to feel better and eventually heal. Children tend to heal more quickly than adults.
If your anemia or nutritional deficiencies are severe, your doctor or dietitian might recommend that you take supplements, including:
Vitamins and supplements are usually taken in pill form. If your digestive tract has trouble absorbing vitamins, your doctor might give them by injection.
Medical follow-up at regular intervals can ensure that your symptoms have responded to a gluten-free diet. Your doctor will monitor your response with blood tests.
For most people with celiac disease, a gluten-free diet will allow the small intestine to heal. For children, that usually takes three to six months. For adults, complete healing might take several years.
If you continue to have symptoms or if symptoms recur, you might need an endoscopy with biopsies to determine whether your intestine has healed.
If your small intestine is severely damaged or you have refractory celiac disease, your doctor might recommend steroids to control inflammation. Steroids can ease severe signs and symptoms of celiac disease while the intestine heals.
Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris), might be used.
If you have this skin rash, your doctor might recommend a medication such as dapsone, taken by mouth, as well as a gluten-free diet. If you take dapsone, you'll need regular blood tests to check for side effects.
If you have refractory celiac disease, your small intestine won't heal. Then you'll likely need to be evaluated in a specialized center. Refractory celiac disease can be quite serious, and there is currently no proven treatment.
If you've been diagnosed with celiac disease, you'll need to avoid all foods that contain gluten. Ask your doctor for a referral to a dietitian, who can help you plan a healthy gluten-free diet.
Avoid packaged foods unless they're labeled as gluten-free or have no gluten-containing ingredients, including emulsifiers and stabilizers that can contain gluten. In addition to cereals, pastas and baked goods, other packaged foods that can contain gluten include:
Pure oats aren't harmful for most people with celiac disease, but oats can be contaminated by wheat during growing and processing. Ask your doctor if you can try eating small amounts of pure oat products.
Many basic foods are allowed in a gluten-free diet, including:
Grains and starches allowed in a gluten-free diet include:
It can be difficult, and stressful, to follow a completely gluten-free diet. Here are some ways to help you cope and to feel more in control.
You might be referred to a doctor who treats digestive diseases (gastroenterologist). Here's some information to help you prepare for your appointment.
Until your appointment, continue eating a normal diet. Cutting gluten before you're tested for celiac disease can change the test results.
Make a list of:
For celiac disease, questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you questions, including: