Celiac Disease

Celiac disease is a chronic immune condition caused by a reaction to gluten, a protein found in wheat, barley and rye.

When someone with celiac disease eats gluten, the immune system responds by damaging the lining of the small intestine. This can interfere with the body's ability to absorb nutrients.

Celiac disease can cause digestive symptoms, but it can also affect other parts of the body. Some people have few or no noticeable symptoms.

Celiac disease is different from non-celiac gluten sensitivity and wheat allergy. While these conditions can cause similar symptoms, they do not cause the same type of damage to the small intestine. 

Symptoms of celiac disease can vary from person to person. Some people have digestive symptoms, while others have symptoms that affect other parts of the body.

Common symptoms include:

• Diarrhea

• Abdominal pain or discomfort 

• Bloating

• Gas

• Nausea or vomiting

• Constipation 

• Unexplained weight loss

• Fatigue

• Iron-deficiency anemia

• Bone or joint pain 

• Headaches

• Tingling or numbness in the hands or feet

• Difficulty concentrating, sometimes described as “brain fog”

• An itchy skin rash called dermatitis herpetiformis 

Some people with celiac disease may not have obvious symptoms.

Celiac disease can be difficult to diagnose because its symptoms can overlap with other digestive conditions. Diagnosis typically begins with a gastroenterologist, who reviews your symptoms, medical history and family history and may perform a physical examination.

Your care team may use:

• Blood tests for celiac disease antibodies

• Tests to check for nutritional deficiencies or related health problems 

• Upper gastrointestinal endoscopy

• Biopsies of the small intestine

• Genetic testing in certain situations

• Skin biopsy when dermatitis herpetiformis is suspected 

Blood testing and a biopsy of the small intestine are commonly used to confirm celiac disease. In most cases, diagnostic testing should be completed while you are still eating gluten. Starting a gluten-free diet before testing can affect results and make the condition more difficult to diagnose.

These tests help determine whether celiac disease is present and whether there is damage to the small intestine. Your gastroenterologist will determine which tests are appropriate based on your symptoms, medical history and test results.

The primary treatment for celiac disease is a strict, lifelong gluten-free diet. Removing gluten allows the small intestine to heal and helps prevent additional damage.

Treatment may also include nutritional support, monitoring for complications and treatment of symptoms or health problems related to celiac disease.

Gluten-free diet

Following a gluten-free diet means avoiding foods and drinks that contain wheat, barley, rye and sometimes oats. Even small amounts of gluten can cause intestinal damage in people with celiac disease.

A registered dietitian can help you learn how to identify sources of gluten, read food labels, avoid cross-contact and maintain a balanced diet while following a gluten-free diet.

Your care team may also evaluate you for vitamin and mineral deficiencies and recommend supplements when needed.

Monitoring and follow-up

Celiac disease requires ongoing medical follow-up, even after symptoms improve.

Your care team may monitor:

• Symptoms and digestive health

• Celiac disease antibody levels

• Vitamin and mineral levels

• Bone health

• Weight and nutritional status

• Response to a gluten-free diet

If symptoms continue despite following a gluten-free diet, your care team can evaluate whether you may be unintentionally consuming gluten or whether another condition is contributing to your symptoms.

Non-responsive celiac disease

Most people with celiac disease improve after starting a strict gluten-free diet. Non-responsive celiac disease refers to ongoing symptoms or intestinal damage despite treatment.

There are several possible reasons why symptoms may continue. Unintentional gluten exposure is a common cause, but other digestive conditions, nutritional deficiencies or complications of celiac disease may also cause persistent symptoms.

Your care team may review your diet, repeat testing or perform additional evaluations to determine why symptoms are continuing.

Refractory celiac disease

Refractory celiac disease, also called refractory sprue, is a rare complication in which symptoms and intestinal damage continue despite a strict gluten-free diet and after other possible causes have been ruled out.

Refractory celiac disease requires specialized evaluation and treatment. Your gastroenterology team may use additional blood tests, endoscopy, small intestine biopsies and other testing to determine the cause and guide treatment.

Because refractory celiac disease is rare and can be associated with serious complications, care from gastroenterologists with expertise in celiac disease is important.

UC Health offers specialized digestive disease care through a team of gastroenterologists and other specialists who work together to diagnose and manage complex digestive conditions. UC Health Gastroenterology and Hepatology provides an integrated approach to diagnosing and treating digestive disorders, with advanced endoscopic procedures available to help evaluate challenging gastrointestinal conditions.

UC Health also has gastroenterology expertise specifically focused on celiac disease and small bowel disorders, including care that emphasizes accurate diagnosis, long-term management and advancing treatment options through research.

If you have symptoms that may be related to celiac disease or have concerns about gluten intolerance, UC Health's digestive disease specialists can help determine whether testing is appropriate. If you have not yet been tested, talk with your health care provider before starting a gluten-free diet, as avoiding gluten can affect diagnostic testing.

Schedule an appointment to receive an evaluation and learn more about your treatment options.

Call 513-475-7505.