Call GI North Today!

(404) 446-0600

View the GI North Facebook Page!

Facebook

View the GI North Twitter Page!

Twitter

View the GI North YouTube Page!

YouTube

View the GI North Blog!

Blog

Celiac Disease

Celiac disease is a digestive disease caused by intolerance to gluten, a protein found in wheat, rye, and barley. If you have celiac disease and you consume foods or use products that contain gluten, your immune system can damage your small intestine and lead to malnutrition. While symptoms in children can include chronic diarrhea, vomiting, or constipation, adults with celiac disease can suffer from fatigue, joint pain, missed menstrual cycles, tingling/numbness in hands or feet, and an itchy skin rash. There is no cure for celiac disease. However, a gluten free diet can stop all symptoms. If you think you might have celiac disease or one of your parents or siblings have celiac disease, let Dr. Cofrancesco, Dr. Quijano and the staff at GI North help alleviate your current symptoms and provide direction on starting a gluten-free diet.

To learn more about celiac disease and questions like “What is gluten?” continue reading below.

  • What is celiac disease?
  • What are the symptoms of celiac disease?
  • Why are celiac disease symptoms so varied?
  • What other health problems do people with celiac disease have?
  • How common is celiac disease?
  • How is celiac disease diagnosed?
  • How is celiac disease treated?
  • The Gluten-free Diet: Some Examples
  • Points to Remember

What is celiac disease?

Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medicines, vitamins, and lip balms. When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, you become malnourished, no matter how much food one eats.

Celiac disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. Celiac disease is genetic, meaning it runs in families. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

What are the symptoms of celiac disease?

Symptoms of celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body.

Digestive symptoms are more common in infants and young children and may include:

  • abdominal bloating and pain
  • chronic diarrhea
  • vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss

Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may instead have one or more of the following:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss or osteoporosis
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • an itchy skin rash called dermatitis herpetiformis

People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition—which can lead to anemia, osteoporosis, and miscarriage, among other problems—liver diseases, and cancers of the intestine.

Why are celiac disease symptoms so varied?

Researchers are studying the reasons celiac disease affects people differently. The length of time you were breastfed, the age you started eating gluten-containing foods, and the amount of gluten-containing foods one eats are three factors thought to play a role in when and how celiac disease appears. Some studies have shown, for example, that the longer you were breastfed, the later the symptoms of celiac disease appear.

Symptoms also vary depending on your age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer you go undiagnosed and untreated, the greater the chance of developing long-term complications.

What other health problems do people with celiac disease have?

People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues.

The connection between celiac disease and these diseases may be genetic, they include:

  • type 1 diabetes
  • autoimmune thyroid disease
  • autoimmune liver disease
  • rheumatoid arthritis
  • Addison’s disease, a condition in which the glands that produce critical hormones are damaged
  • Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed

How common is celiac disease?

Celiac disease affects people in all parts of the world. Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder. More than 2 million people in the United States have the disease, or about 1 in 133 people.* Among people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, as many as 1 in 22 people may have the disease.**

Celiac disease is also more common among people with other genetic disorders including Down syndrome and Turner syndrome, a condition that affects girls’ development.

*Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Archives of Internal Medicine. 2003;163(3):268–292.

**Ibid.

How is celiac disease diagnosed?

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been under diagnosed or misdiagnosed. As the medical field becomes more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.

Blood Tests

People with celiac disease have higher than normal levels of certain autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. To diagnose celiac disease, Dr. Cofrancesco or Dr. Quijano will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.

Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If you stop eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.

Intestinal Biopsy

If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis. During the biopsy, Dr. Cofrancesco or Dr. Quijano removes tiny pieces of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, Dr. Cofrancesco or Dr. Quijano eases a long, thin tube called an endoscope through your mouth and stomach into the small intestine. Dr. Cofrancesco or Dr. Quijano then takes the samples using instruments passed through the endoscope.

Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with celiac disease.*** The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of celiac disease.

DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, you do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as dapsone. Because dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.

Screening

Screening for celiac disease means testing for the presence of autoantibodies in the blood in people without symptoms. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to twelve percent of an affected person’s first-degree relatives will also have the disease.****

***Rodrigo L. Celiac disease. World Journal of Gastroenterology. 2006;12(41):6585–6593.

****Ibid.

How is celiac disease treated?

The only treatment for celiac disease is a gluten-free diet. Dr. Cofrancesco or Dr. Quijano may ask a newly diagnosed person to work with a dietitian on a gluten-free diet plan. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.

For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in three to six months in children but may take several years in adults. A healed intestine means you now have villi that can absorb nutrients from food into the bloodstream.

To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on your age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.

Some people with celiac disease show no improvement on the gluten-free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.

Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. Researchers are evaluating drug treatments for refractory celiac disease.

The Gluten-free Diet

A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. In other words, if you have celiac disease you should not eat most grain, pasta, cereal, and many processed foods.

Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from mainstream stores.

“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can freely eat these foods. In the past, people with celiac disease were advised not to eat oats. New evidence suggests that most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should work closely with a dietician when deciding whether to include oats in their diet. Examples of other foods that are safe to eat and those that are not are provided in the table.

The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with celiac disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they grab for a snack. Eating out can be a challenge. When in doubt about a menu item, you should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.

Gluten is also used in some medications. People with celiac disease should ask a pharmacist if prescribed medications contain wheat. Because gluten is sometimes used as an additive in unexpected products—such as lipstick and play dough—reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature.

New Food Labeling
The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect on January 1, 2006, requires food labels to clearly identify wheat and other common food allergens in the list of ingredients. FALCPA also requires the U.S. Food and Drug Administration to develop and finalize rules for the use of the term “gluten free” on product labels.

The Gluten-free Diet: Some Examples

In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with celiac disease should discuss gluten-free food choices with  Dr. Cofrancesco or Dr. Quijano. People with celiac disease should always read food ingredient lists carefully to make sure the food does not contain gluten.

Allowed Foods

amaranth
arrowroot
buckwheat
cassava
corn
flax
Indian rice grass
Job’s tears
legumes
millet
nuts
potatoes
quinoa
rice
sago
seeds
sorghum
soy
tapioca
teff
wild rice
yucca

Foods To Avoid

wheat: including einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein barley
rye
triticale (a cross between wheat/rye)

Other Wheat Products

bromated flour
durum flour
enriched flour
farina
graham flour
phosphated flour
plain flour
self-rising flour
semolina
white flour

Processed Foods that May Contain Wheat, Barley, or Rye*

bouillon cubes
brown rice syrup
candy
chips/potato chips
cold cuts, hot dogs, salami, sausage
communion wafers
French fries
gravy
imitation fish
matzo
rice mixes
sauces
seasoned tortilla chips
self-basting turkey
soups
soy sauce
vegetables in sauce

* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.

Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide, please visit www.eatright.org.

Points to Remember

  • People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
  • Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
  • Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
  • A person with celiac disease may or may not have symptoms.
  • Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
  • Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
  • Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
  • A dietician can advise you about food selection, label reading, and other strategies to help manage the disease.

Fill out my online form.