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Celiac Disease

Last updated Jan. 15, 2019

Approved by: Krish Tangella MD, MBA, FCAP

It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications. DoveMed found this great personal video where a celiac disease patient describes her symptoms of bloating, constipation and mouth ulcers. She also explains how her condition has improved by switching to a gluten-free diet.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Gluten Intolerance
  • Non-Tropical Sprue
  • Wheat-Sensitive Enteropathy

What is Celiac Disease? (Definition/Background Information)

  • Celiac Disease (CD) affects the digestive system, leading to damage of the small intestine. The small intestine is a part of the gastrointestinal tract, where nutrients are absorbed.
  • The signs and symptoms of this autoimmune disorder may include foul-smelling greasy stools, abdominal pain, skin rashes that itch, weight-loss, malnutrition, and chronic diarrhea.
  • Celiac Disease is a hereditary disease that involves the destruction of villi, which are finger-like protrusions, on the inner walls of the small intestine. The villi play an important role in the absorption of nutrients in the small intestine.
  • Individuals affected by Celiac Disease are intolerant to gluten, a protein found in wheat, barley, rye, etc. and in products containing gluten. Hence, avoiding gluten in one’s diet, is the recommended treatment method.
  • Celiac Disease may not be preventable, since it is thought to be a genetic condition.
  • The prognosis is dependent on factors, such as the age of the individual, and the severity of the Celiac Disease. In many individuals, removing gluten from diet significantly improves symptoms. However, a complete avoidance of gluten in the diet alone may not be sufficient, in some cases.

Who gets Celiac Disease? (Age and Sex Distribution)

  • Celiac Disease affects individuals of all ages and both sexes
  • Women are more to prone to the condition, than men
  • It is a hereditary disease; individuals with a family medical history of the disease, are more prone to developing Celiac Disease
  • Though it affects people of all parts of the world; geographically, individuals of north European descent, appear to have a higher risk

What are the Risk Factors for Celiac Disease? (Predisposing Factors)

Certain individuals are at an increased risk for Celiac Disease, such as those affected by the following conditions:

  • Type 1 diabetes
  • Autoimmune thyroid disease
  • Autoimmune liver disease
  • Rheumatoid arthritis
  • Addison's disease
  • Sjögren syndrome
  • Individuals, who have a first-degree relative diagnosed with Celiac Disease, have a higher risk
  • Genetic disorders, such as Down syndrome, Turner syndrome, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Celiac Disease? (Etiology)

  • The exact cause of Celiac Disease is unknown
  • It is thought to be a genetic disorder due to anomalies in certain genes
  • The disease involves intolerance to gluten; a protein found in wheat, barley, rye and their products
  • Medical research is yet to establish other factors that might be responsible for the development of the disease

What are the Signs and Symptoms of Celiac Disease?

The signs and symptoms of Celiac Disease vary from one individual to another, and are dependent upon the age, sex of the individual, and severity of the disease. The following are possible signs and symptoms of Celiac Disease:

  • Bad smelling, greasy stools
  • Weight loss
  • Itchy skin rashes, called dermatitis herpetiformis
  • Belly pain
  • Longstanding diarrhea
  • Anemia, due to decreased iron absorption in the intestines of the body
  • Feeling of tiredness, fatigue
  • In women - altered menstrual cycle, recurrent miscarriages, and inability to conceive
  • Mouth sores
  • Vomiting and nausea
  • Constipation
  • Decreased growth in children, resulting in short stature and delayed puberty

How is Celiac Disease Diagnosed?

A diagnosis of Celiac Disease may involve:

  • A complete medical history and a thorough physical examination
  • Examination for the presence of any signs and symptoms of malnutrition, like low weight, low hemoglobin levels (anemia), etc.

Additionally, the following tests may be used in the diagnosis of Celiac Disease:

  • Elevated levels of auto-antibodies, called anti-tissue transglutaminase antibodies (tTG), or anti-endomysium antibodies (EMA) are generally found in blood. Autoantibodies are agents produced in the body against one’s own body proteins and enzymes altering their function. Sometimes, the results may be negative for Celiac Disease, even if the disease is present. This usually occurs, when the patient stops taking gluten in their diet, before the blood test
  • Intestinal biopsy: Tiny pieces of tissues from the small intestine are removed, to check for damage to the villi. A long, thin tube called an endoscope is passed through the mouth into the stomach and the small intestine. Certain instruments are passed through the endoscope, to obtain pieces of the small intestine, which are then examined under a microscope, by a pathologist

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Celiac Disease?

Multiple complications might occur from Celiac Disease (CD) and these are not limited to the consequence of malnutrition alone. A few of them include:

  • Weakened bones (osteoporosis) due to decreased absorption of nutrients from the gut, leading to a higher incidence of fractured bones
  • Though rare, there is an elevated risk of lymphoma of the gut, in later stages of one’s life
  • Complications arising due to coexisting autoimmune diseases: These are diseases arising from an inappropriate immune response of the body, to substances and tissues normally present in the body, like insulin-dependent type 1 diabetes, thyroid disease, Sjögren’s syndrome, Addison’s disease, autoimmune liver disease, etc. These coexisting autoimmune disorders do not cause Celiac Disease, but they add to the set of potential complications
  • Women with CD may give birth to low birth weight babies
  • Some individuals have decreased sensations in their hands and feet
  • Increased risk of having seizures

How is Celiac Disease Treated?

Currently, having a gluten-free diet is the main treatment available for Celiac Disease.

  • Patients may also require a dietary supplementation of calcium, vitamins, and other minerals
  • In severe cases, steroids may be used to decrease inflammation of the intestine

A lists of foods that are to be avoided and those that are allowed, are provided below. It is important to consult professional healthcare personnel, to determine the exact food item that one may or may not consume. The following list is for information purposes only; but, it generally holds true for a majority of cases. Some individuals may have a different list of approved food items.

In most individuals, the foods to avoid in Celiac Disease include:

  • Wheat and its products
  • Barley and its products
  • Rye and its products
  • Beer
  • Cakes and pies
  • Pizza crust
  • Pasta

In most individuals, the foods allowed in Celiac Disease include:

  • Cornmeal
  • Buckwheat
  • Amaranth
  • Arrowroot
  • Nuts and legumes
  • Seeds
  • Rice
  • Potatoes
  • Sago
  • Sorghum
  • Soy
  • Vegetables and fruits
  • Wines and other distilleries

Gluten is also used in certain medications. Hence, it is advisable to confirm with the healthcare provider, if any of the medications prescribed contain gluten.

How can Celiac Disease be Prevented?

Currently, there is no way to prevent an individual from developing Celiac Disease.

What is the Prognosis of Celiac Disease? (Outcomes/Resolutions)

  • In many individuals, avoiding gluten completely in their diet will heal the intestinal damage, as well as stop the symptoms of Celiac Disease; improvement of symptoms may be seen in days
  • A complete healing of the small intestine can take months and this primarily depends on the age of the patient
  • However, some abnormalities, like dental enamel defects and short stature, may not show any improvement, beyond a certain age
  • Sometimes, even taking a gluten-free diet may not improve one’s health condition, which is the case with Refractory Celiac Disease. Individuals affected by this type of Celiac Disease, have a severely damaged intestine and the nutrients may have to be fed intravenously, into their blood

Additional and Relevant Useful Information for Celiac Disease:

  • Celiac Disease is also known as Non-Tropical Sprue. However, there is another condition known as tropical sprue. Celiac Disease should not be confused with tropical sprue

The following article link will help you understand tropical sprue:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 28, 2014
Last updated: Jan. 15, 2019