Celiac disease is a digestive disease that damages the small
intestine and interferes with absorption of nutrients from food.
People who have celiac disease cannot tolerate a protein called
gluten, which is found in wheat, rye, barley, and possibly
When people with celiac disease eat foods containing gluten,
their immune system responds by damaging the small intestine.
Specifically, tiny fingerlike protrusions, called villi, on
the lining of the small intestine are lost. Nutrients from food are
absorbed into the bloodstream through these villi. Without villi, a
person becomes malnourished—regardless of the quantity of food
Because the body's own immune system causes the damage, celiac
disease is considered an autoimmune disorder. However, it is
also classified as a disease of malabsorption because nutrients are
not absorbed. Celiac disease is also known as
Celiac disease is a genetic disease, meaning that it runs in
families. Sometimes the disease is triggered (becomes active for
the first time) after surgery, pregnancy, childbirth, viral
infection, or severe emotional stress.
How Common is Celiac Disease?
Celiac disease is the most common genetic disease in Europe. In
Italy, about one in 250 people, and in Ireland, about one in 300
people have celiac disease. It is rarely diagnosed in African,
Chinese, and Japanese people. An estimated one in 4,700 Americans
have been diagnosed with celiac disease.
What Are the Symptoms of Celiac Disease?
Celiac disease affects people differently. Some people develop
symptoms as children, others as adults. One factor thought to play
a role in when and how celiac appears is whether and how long a
person was breastfed—the longer one was breastfed, the later
symptoms of celiac disease appear, and the more atypical the
symptoms. Other factors include the age at which one began eating
foods containing gluten and how much gluten is eaten.
Symptoms may or may not occur in the digestive system. For
example, one person might have diarrhea and abdominal pain, while
another person has irritability or depression. In fact,
irritability is one of the most common symptoms in children.
Symptoms of celiac disease may include one or more of the
Recurring abdominal bloating and pain
Pale, foul-smelling stool
Unexplained anemia (low count of red blood cells)
Failure to thrive in infants
Pain in the joints
Tingling numbness in the legs (from nerve damage)
Pale sores inside the mouth, called aphthous ulcers
Painful skin rash, called dermatitis herpetiformis
Tooth discoloration or loss of enamel
Missed menstrual periods (often because of excessive weight
Anemia, delayed growth, and weight loss are signs of
malnutrition (not getting enough of certain nutrients)
Malnutrition is a serious problem for anyone, but particularly
for children because they need adequate nutrition to develop
properly. Some people with celiac disease may not have symptoms.
The undamaged part of their small intestine is able to absorb
enough nutrients to prevent symptoms. However, people without
symptoms are still at risk for the late complications of celiac
To diagnose celiac disease, physicians may test blood to measure
levels of antibodies to gluten. These antibodies are antigliadin,
anti-endomysium, and antireticulin. If the tests and symptoms
suggest celiac disease, the physician may remove a tiny piece of
tissue from the small intestine to check for damage to the villi.
This is done in a procedure called a
. During a
biopsy, the physician eases a long, thin tube called an endoscope
through the mouth and stomach into the small intestine, and then
takes a sample of tissue using instruments passed through the
endoscope. Biopsy of the small intestine is the best way to
diagnose celiac disease.
It is important that patients continue to eat their normal diet containing gluten in the days and weeks before a biopsy because removing gluten from the diet can rapidly restore the appearance of the small intestine to normal. In the past, some doctors recommended a gluten-free diet as a trial to see if symptoms were improved. This is not good current practice because it does not allow a definitive diagnosis to be made which may adversely affect long-term treatment and follow-up.
Screening for celiac disease involves testing asymptomatic
people for the antibodies to gluten. Americans are not routinely
screened for celiac disease. However, because celiac disease is
hereditary, family members—particularly first-degree relatives of
people who have been diagnosed may need to be tested for the
disease. About 10% of an affected person's first-degree
relatives (parents, siblings, or children) will also have the
The longer a person goes undiagnosed and untreated, the greater
the chance of developing malnutrition and other complications. In
Italy, where celiac disease is common, all children are screened by
age six so that even asymptomatic disease is caught early. In
addition, Italians of any age are tested for the disease as soon as
they show symptoms. As a result of this vigilance, the time between symptom onset and the diagnosis is usually only
two to three weeks. In the U.S., the time between the
first symptoms and diagnosis averages about 10 years.
What is the Treatment for Celiac Disease?
The only treatment for celiac disease is to follow a
—that is, to avoid all foods that contain
gluten. 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, and the small
intestine is usually completely healed—meaning the villi are
intact and working—in three to six months. (It may take up to two
years for older adults.)
The gluten-free diet is a lifetime requirement. Eating any
gluten, no matter how small an amount, can damage the intestine.
This is true for anyone with the disease, including people who do
not have noticeable symptoms.
Depending on a person's age at diagnosis, some problems, such as
delayed growth and tooth discoloration, may not improve. A small
percentage of people with celiac disease do not improve on the
gluten-free diet. These people often have severely damaged
intestines that cannot heal even after they eliminate gluten from
their diets. Because their intestines are not absorbing enough
nutrients, some may need special “elemental” diets or evenmay need to receive intravenous nutrition supplements.
Drug treatments are being evaluated for unresponsive celiac disease.
The Gluten-Free Diet
A gluten-free diet means avoiding all foods that contain wheat
(including spelt, triticale, and kamut), rye, barley, and possibly
oats—in other words, most grain, pasta, cereal, and many processed
foods. Despite these restrictions, people with celiac disease can
eat a well-balanced diet with a variety of foods, including bread
and pasta. For example, instead of wheat flour, people can use
potato, rice, soy, or bean flour. Or, they can buy gluten-free
bread, pasta, and other products from special food companies.
Whether people with celiac disease should avoid oats is
controversial because some people have been able to eat oats
without having a reaction. Scientists are doing studies to find out
whether people with celiac disease can tolerate oats. Until the
studies are complete, people with celiac disease should follow
their physician or dietitian's advice about eating oats.
Plain meat, fish, rice, fruits, and vegetables do not contain
gluten, so people with celiac disease can eat as much of these
foods as they like.
The gluten-free diet is complicated. It requires a completely
new approach to eating that affects a person's entire life. People
with celiac disease have to be extremely careful about what they
buy for lunch at school or work, eat at cocktail parties, or grab
from the refrigerator for a midnight snack. Eating out can be a
challenge as the person with celiac disease learns to scrutinize
the menu for foods with gluten and question the waiter or chef
about possible hidden sources of gluten. Alcoholic drinks can be a special challenge. However, with practice,
dodging gluten becomes second nature and people learn to
recognize which foods are safe and which are off limits.
A dietitian can help people learn about their new diet.
Also, support groups are particularly helpful for newly diagnosed
people and their families as they learn to adjust to a new way of
What Are the Complications of Celiac Disease?
Damage to the small intestine and the resulting problems with
nutrient absorption put a person with celiac disease at risk for
several diseases and health problems.
are types of cancer
that can develop in the intestine, perhaps even when celiac disease is properly treated with a gluten free diet.
is a condition in which the bones become
weak, brittle, and prone to breaking. Poor calcium absorption is a
contributing factor to osteoporosis.
baby, such as neural tube defects, are risks for untreated pregnant
women with celiac disease because of malabsorption of
results when childhood celiac disease
prevents nutrient absorption during the years when nutrition is
critical to a child's normal growth and development. Children who
are diagnosed and treated before their growth stops may have a
, or convulsions, result from inadequate
. Lack of folic acid causes calcium
deposits, called calcifications, to form in the brain, which in
turn cause seizures.
Diseases Linked to Celiac Disease
People with celiac disease tend to have other autoimmune
diseases as well, including
The connection between celiac and these diseases may be
genetic. Because the incidence of celiac disease is relatively high in children with type 1 diabetes, some have recommended that all such children be screened for the disease.
The National Institutes of
Health (NIH), July 1999
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