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What Is Celiac Disease?

Symptoms, Diagnosis and Treatment

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Updated April 06, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Celiac disease, also known as coeliac disease, celiac sprue and gluten enteropathy, is a condition in which eating gluten, a protein found in wheat, barley and rye, causes damage in your small intestine. People who have celiac disease cannot absorb nutrients from their food, and the condition can lead to complications, such as malnutrition, osteoporosis, infertility, and even cancer.

Celiac disease affects approximately one in every 100 Americans. However, most — 90% or more — don't realize they have the condition. Because it has such a wide range of potential symptoms, celiac frequently is mistaken for other conditions or is overlooked entirely. The average patient waits more than four years for an official celiac disease diagnosis.

However, awareness of celiac disease is improving dramatically as more people speculate that gluten could be at the root of their health problems. Over the past few years, diagnosis of the condition has risen sharply, as well. In addition, the gluten-free diet (the only current treatment for celiac disease) has gotten easier, as more food manufacturers produce products that are safe to eat.

Although celiac disease once was thought to affect primarily children, it's now clear that people of any age can be diagnosed.

Some people may suffer from celiac disease symptoms, but have negative test results for the condition. In that case, they may be diagnosed with non-celiac gluten sensitivity, a newly-recognized and as yet undefined condition. Not all physicians agree that gluten sensitivity exists, and there's no accepted way to test for it yet.

Read more on gluten sensitivity:
What Is Gluten Sensitivity?
Gluten Sensitivity vs. Celiac Disease

Celiac Disease: An Autoimmune Reaction

Celiac disease is an autoimmune condition, which means it involves a problem with your immune system that causes your disease-fighting white blood cells to attack your own tissue. In celiac disease, gluten ingestion triggers your white blood cells to attack the lining of your small intestine.

Normally, the lining of your small intestine is made up of tiny, finger-like projections called villi. However, when someone with celiac disease eats a gluten-containing food, the gluten triggers their white blood cells to attack those little fingers, ultimately eroding that lining until it's worn smooth.

Since your villi help you digest foods, losing them to celiac disease causes major problems.

You need two things to have celiac disease: the genetic potential to develop it, plus gluten in your diet. Without one or the other, you won't develop the condition.

Some experts believe you also need some sort of "trigger" that causes you to develop celiac disease. For example, some people seem to suffer suddenly from symptoms following a bad stomach illness (a potential trigger), and many women report the onset of symptoms after a pregnancy (another potential trigger). However, other celiacs report a gradual onset of symptoms, and it's not clear if you really do require a trigger to develop the condition.

Read more on celiac disease's causes and the damage it causes in your intestine:
Causes of Celiac Disease
Villous Atrophy in Celiac Disease

Multiple Symptoms Linked to Celiac Disease

It's a myth that you need to have diarrhea and weight loss in order to have celiac disease — in fact, the majority of celiacs aren't underweight, and many have constipation instead of diarrhea.

In fact, there are more than 200 potential celiac disease symptoms. Even though you might think of celiac as primarily a digestive problem, the condition can affect all your body's systems, from your brain to your skin.

Many people with celiac disease don't even report any intestinal problems — they may only have joint pain, possibly combined with brain fog or even attention deficit-hyperactivity disorder. Others may have what's known as silent celiac disease, which means they don't have any symptoms at all, but still have the intestinal damage that characterizes celiac disease.

Read more on celiac disease symptoms:
Celiac Disease Symptoms: An Overview
Celiac Disease Symptoms in Women
Celiac Disease Symptoms in Men
Celiac Disease Symptoms in Children
Non-Digestive Celiac Disease Symptoms
Celiac Disease and Your Skin

Diagnosing Celiac Disease Takes Blood Test, Biopsy

It's unfortunately not always straightforward to diagnose celiac disease — in fact, it usually takes multiple blood tests plus a procedure known as an endoscopy to determine if you have celiac.

The blood tests, which usually represent the first step in the diagnosis process, screen your blood for high levels of antibodies associated with your body's reaction to gluten in your diet. Because the tests look for the actual reaction to gluten, you must be eating a gluten-containing diet for them to be accurate.

If the blood tests come back positive, in most cases the next step is an endoscopy, in which a surgeon uses an instrument to look directly at your small intestine and take samples of your intestinal lining.

In order to be officially diagnosed with celiac disease, those samples of your intestinal lining must show the villous atrophy that's characteristic of the condition. However, it's also possible to obtain a diagnosis through skin testing if you have an itchy, gluten-related rash known as dermatitis herpetiformis.

Read more about diagnosing celiac disease:
Celiac Disease Testing
Celiac Disease Blood Tests
Celiac Disease Genetic Testing
Dermatitis Herpetiformis Diagnosed By Skin Biopsy

Celiac Disease Treatment: The Gluten-Free Diet

Although there currently are several potential drugs for celiac disease in development, there's only one treatment you can use right now: the gluten-free diet.

To treat the damage caused by gluten, you need to eliminate gluten from your diet. Once you do that, your intestinal lining will begin to heal, and other complications from celiac disease (such as malnutrition) should begin to resolve.

Read more on the gluten-free diet:
What Is Gluten, and Why Is It So Difficult to Avoid?
What's Involved in Following the Gluten-Free Diet
Nine Steps to Go Gluten-Free
Where You'll Find Hidden Gluten

Following a gluten-free diet isn't easy; in fact, it takes a fair amount of research and practice before you can expect to get it right and get rid of all the gluten. However, even if you slip up occasionally as you learn how to follow the diet, you likely will begin to feel better pretty quickly ... and that makes the diet worthwhile.

Sources:

Celiac Disease Center at Columbia University. What Is Celiac Disease?. Accessed Jan. 5, 2012.

National Digestive Diseases Information Clearinghouse. Celiac Disease. Accessed Jan. 5, 2012.

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