Celiac Disease (CD)

Celiac disease is a genetic autoimmune condition disease that mainly affects the gastrointestinal tract when gluten is ingested. Gluten is a protein found in wheat, barley, and rye. When someone with CD eats gluten, the lining of the small intestine becomes damaged and is unable to absorb nutrients properly.

Symptoms of Celiac Disease

There are over 200 symptoms of CD and they vary so widely that there is no such thing as a typical case. Many people do not experience any of the gastric symptoms that were previously thought to typify the condition. These individuals often face a delay in diagnosis.

Physical Symptoms May Include

Abdominal cramping

Amenorrhea (absence of menstruation)

Anemia

Bloating/distention

Brain fog/inability to concentrate

Canker sores

Constipation

Dental abnormalities

Diarrhea

Edema/swelling

Electrolyte imbalance

Elevated liver enzymes

Fatigue

Headaches

Infertility/miscarriage

Osteopenia/ osteoporosis

Pain in bones and joints

Peripheral neuropathy

Rash (see dermatitis herpetiformis)

Stool abnormalities

Vitamin and mineral deficiencies

Vomiting

Weight loss or gain

Emotional Symptoms May Include

Anxiety

Depression

Irritability

Mood changes

Common Symptoms in Children

Children with CD may exhibit any of the previously listed symptoms as well as:

Failure to thrive

Delayed puberty

ADHD-like symptoms

Diagnosis

The steps leading to a diagnosis of celiac disease are:

• A thorough physical examination with complete medical history.
• Blood work that includes a celiac panel. A celiac panel will measure the number of particular antibodies in the blood. The most common tests include: TG (tissue transglutaminase antibody) and total serum IgA. Other available tests include an EMA (endomysial antibody), DGP (deaminated gliadin peptide), IgA, and IgG.
• An upper endoscopy with several biopsies of the small intestine including the duodenum.

It is important to continue to consume gluten throughout the testing process. Failure to do so can lead to a false negative or an inconclusive result.

It’s important to go through the testing process to get an accurate diagnosis since other serious medical conditions can present in a similar way to CD and need to be ruled out. Additionally, keeping to a lifelong, strict GF diet can be burdensome and is more difficult to maintain without a proven medical need. Once you are diagnosed with CD and a GF diet has started, your antibody levels will start to drop and your villi will heal.

Treatment of Celiac Disease

Currently the only treatment for CD is the lifelong adherence to a strict gluten-free (GF) diet.

All food that either contains gluten or might have had contact with gluten (known as cross-contact) must be avoided. Even levels of cross-contact that do not produce a noticeable reaction may cause damage to the intestine and should be avoided.

People with CD must watch for cross-contact and/or items that have been used with gluten containing food and cannot be sufficiently cleaned. For example:

toasters, toaster ovens, air fryers

food preparation surfaces

condiments and spreads

shared utensils

colanders/strainers

deep fryers

It takes time to heal, but for most people, keeping to a strict GF diet can result in an improvement in symptoms.

Do not start a GF diet without first confirming the diagnosis of CD, NCGS, or DH with your doctor. The diagnosis of CD is based upon blood tests and a biopsy of the small intestine. If testing is done after a GF diet is started, blood tests can normalize, the small intestine may heal, and your doctor will be unable to make an accurate diagnosis.