Celiac Disease

Overview

Gluten intolerance is an autoimmune disease in which the body mounts an immune response against gluten after consuming this protein, which is found in wheat, barley, and rye. This immune response can cause symptoms such as diarrhea, headaches, fatigue, abdominal pain, weight loss, nausea and vomiting, bloating and gas, and constipation.

Celiac disease is the most severe form of gluten intolerance, as people with celiac disease experience damage to the intestinal lining with repeated exposure to gluten. This damage hinders the body’s ability to absorb nutrients from the stomach, which can further impact the individual’s health.

Your doctor can administer tests to diagnose gluten intolerance and celiac disease if you have been experiencing symptoms.

Gluten intolerance causes

The symptoms of gluten intolerance result from one’s immune system overreacting to dietary gluten.

Researchers do not know what causes the development of this immune response. Some possible causes include:

• Infant feeding practices
• Genetic factors
• Gastrointestinal infections
• Gut bacteria
• Intestinal changes after surgery, pregnancy and childbirth, viral infection or severe emotional distress

In people with celiac disease specifically, the miniscule, hair like projections (villi) that line the small intestine are damaged through this immune reaction, which decreases their ability to absorb nutrients from the foods you eat.

Gluten intolerance risk factors

Celiac disease occurs more common in people with:

• A family member with celiac disease or dermatitis herpetiformis
• Type 1 diabetes
• Down syndrome or Turner syndrome
• Autoimmune thyroid disease
• Microscopic colitis
• Addison's disease

Gluten intolerance symptoms

Signs and symptoms of gluten intolerance can present very differently in children versus adults.

Adults may experience digestive issues such as:

• Diarrhea
• Weight loss
• Bloating and gas
• Abdominal pain
• Nausea and vomiting
• Constipation

Many adults with celiac disease also have additional signs and symptoms beyond those affecting the digestive system. These symptoms may include:

• Anemia or iron deficiency
• Loss of bone density (osteoporosis)
• Bone softening (osteomalacia)
• Itchy, blistery skin rash (dermatitis herpetiformis)
• Mouth ulcers
• Headaches
• Fatigue
• Nervous system injury, such as numbness and tingling in the feet and hands, impaired cognitive functioning, and trouble with balancing
• Joint pain
• Impaired spleen functioning (hyposplenism)

Children with celiac disease may have digestive problems such as:

• Nausea and vomiting
• Chronic diarrhea
• Swollen belly
• Constipation
• Gas
• Pale, foul-smelling stools

Gluten intolerance complications

If left untreated, celiac disease can cause:

• Malnutrition — If your small intestine is damaged and cannot adequately absorb nutrients, you may develop malnutrition, which can lead to anemia and weight loss in adults, and impaired growth in children. 
• Weakened bones — A decreased ability to absorb calcium and vitamin D can lead to bone softening in children and decreased bone density in adults. 
• Infertility and miscarriage — Reproductive problems can result from a compromised ability to absorb calcium and vitamin D.
• Lactose intolerance — Damaged villi in your small intestine may lead to symptoms of lactose intolerance, such as experiencing abdominal pain and diarrhea after consuming dairy products containing the sugar lactose.
• Cancer — People with untreated celiac disease have an increased risk of developing intestinal lymphoma and small bowel cancer.
• Nervous system problems — Untreated celiac disease can lead to seizures or peripheral neuropathy, a disease of the nerves to the hands and feet
• Dermatitis herpetiformis — This is an itchy, blistering rash that usually appears on the elbows, knees, torso, scalp and buttocks.

In addition to causing the symptoms seen in adulthood, the malabsorption caused by celiac disease can impact children’s growth and development. Consequences of this malabsorption may include:

• For infants, failure to thrive
• Tooth enamel damage
• Weight loss
• Anemia
• Irritability
• Shorter height
• Delayed puberty
• Neurological symptoms such as:
  • ADHD
  • Learning disabilities
  • Headaches
  • Lack of muscle coordination
  • Seizures

Gluten intolerance diagnosis

The two blood tests that can help diagnose celiac disease are:

• Serology testing — which looks for elevated levels of certain antibody proteins may signal an immune reaction to gluten
• Genetic testing — that looks for human leukocyte antigens, and can rule out the presence of celiac disease

If you plan to get tested for celiac disease, talk to your doctor before adopting a gluten-free diet. Removing gluten from your diet before the test can impact test results.

If these test results suggest celiac disease, your doctor may then order a:

• Endoscopy — Your doctor inserts a long tube with a tiny camera into your mouth and down your throat to view your small intestine, and to take a small tissue sample to assess any villi damage.
• Capsule endoscopy — The patient swallows a small, vitamin-sized wireless camera that takes thousands of pictures of your small intestine as it travels through the digestive tract.

Gluten intolerance treatment

There is currently no cure for celiac disease. Maintaining a strict gluten-free diet should help manage symptoms and prevent further intestinal damage.

When to seek care

Consult your doctor about getting tested for celiac disease if:

• You have diarrhea or digestive discomfort lasting for more than two weeks
• You have a family member with the condition
• You have a risk factor such as type 1 diabetes

Consult your child’s doctor if your child:

• Is pale, irritable or failing to grow
• Has a potbelly and bulky, foul-smelling stools

Next Steps

Long-term management of gluten intolerance and celiac disease involves creating a diet that stays free of gluten. A dietician can help set up such a plan.

Following a celiac disease diagnosis, a doctor may prescribe:

• Vitamin and mineral supplements to treat anemia and nutritional deficiencies
• Medication to control inflammation in the small intestine
• Daspone, to treat dermatitis herpetiformis, if present

If you are still experiencing symptoms of celiac disease several months after implementing a gluten-free diet, you may have:

• Nonresponsive celiac disease — Some people with celiac disease find that their symptoms do not improve after changing their diet. Usually, this means that what they thought was a gluten-free diet is still contaminated by gluten in some way.

  Other causes of non-responsive celiac disease may include:

  • Bacteria in the small intestine, or bacterial overgrowth
  • Microscopic colitis
  • Impaired pancreas function, or pancreatic insufficiency
  • Irritable bowel syndrome (IBS)
  • Difficulty digesting lactose, sucrose, or fructose
  • Refractory celiac disease
• Refractory celiac disease — In rare cases, a pure gluten-free diet does not cease the intestinal injury in patients with celiac disease. You may need to undergo additional testing to identify other possible causes of your symptoms, if they persist after six months to a year.

Gluten can “hide” in food and non-food products we might not expect. Consult a dietician to create a more detailed and comprehensive plan for avoiding gluten.