Celiac Disease Symptoms, Causes & Treatment Options

Celiac disease is a long-term health condition caused by the body’s immune defense system reacting against a protein called gluten, found in wheat, barley, and rye. Symptoms include diarrhea, weight loss, abdominal pain, fatigue, bloating, flatulence, nausea and vomiting, and constipation.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Celiac Disease?

Summary

Celiac disease may affect about one in 100 people [1]. It is typically diagnosed in child- or young adulthood but can be diagnosed at any age. In this condition, the body’s own immune system becomes activated by gluten. This activation causes an autoimmune response whereby the immune system begins to inappropriately recognize and attack certain components of your organs. The cells lining the small intestine are most often affected. This results in the hallmark symptoms of diarrhea, weight loss, abdominal pain, fatigue, bloating, flatulence, nausea and vomiting, and constipation. Treatment is partial or complete avoidance of gluten-containing foods and beverages.

Recommended care

Celiac Disease Symptoms

Main symptoms

The following symptoms are typical and are the result of the immune system’s attack on the intestinal lining [2].

  • Diarrhea
  • Weight loss
  • Belly pain
  • Fatigue
  • Bloating
  • Flatulence
  • Nausea
  • Vomiting
  • Constipation

Other symptoms

Approximately 50% of people with celiac disease may also have one or more of the following symptoms.

  • Joint pains
  • Arthritis: This condition involves remodeling of the joints as well as joint pain.
  • Neurologic issues: Numbness or tingling, seizures, and ataxia (inability to move correctly) may occur.
  • Low blood count (anemia): This condition predominantly results in feeling tired.
  • Osteoporosis or osteomalacia: These conditions involve the breakdown and remodeling of bone.
  • Delayed menstrual period or infertility
  • Dermatitis herpetiformis: skin blistering
  • Oral ulcers
  • Vitamin deficiencies

Symptoms in children and adolescents

The following symptoms may present in younger people with the disease.

  • Behavioral problems
  • Shortened stature
  • Fatigue

Long-term complications

If left untreated, celiac disease can increase the risk of developing the following conditions [3].

  • Lymphoma (a kind of tumor)
  • Adenocarcinoma (a kind of tumor)
  • Problems fighting off cancer of the digestive tract and bile duct
  • Miscarriage
  • Congenital malformation of a fetus

Celiac Disease Causes

While celiac disease is diagnosed worldwide in one in 3000 people, it affects approximately one in 100 people in the Western world. The disease is commonly diagnosed in people 8 to 12 months of age or 20 to 40 years old [3]. The disease is strongly heritable. To develop the disease, there is a combination of genetic and environmental factors, which trigger an immune system response to gliadin, a piece of a protein found in gluten [4]. Gluten itself is found in wheat, barley, and rye. The immune system then falsely identifies proteins in your body as invaders and attacks them. This attack leads to the symptoms of celiac disease over time.

Triggers of celiac disease

The following dietary items trigger the immune system to attack the body in susceptible individuals [6,7].

  • Wheat (and its derivatives)
  • Barley
  • Rye
  • Triticale
  • Malt
  • Brewer’s yeast
  • Wheat starch

Foods that contain gluten

These foods commonly contain gluten unless noted otherwise [5,6].

  • Pasta/noodles
  • Bread
  • Pastries
  • Crackers
  • Tortillas
  • Cakes/pies
  • Cereals
  • Pancakes/waffles/French toast
  • Any sauce that uses wheat flour for thickening
  • Soy sauce
  • Beer

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Treatment Options, Relief, and Prevention for Celiac Disease

Diagnosis

To diagnose celiac disease, there is a blood test for antibodies to immunoglobulin A anti-tissue transglutaminase antibody (IgA TTG) and possible IgG-deamidated gliadin peptide. An endoscopy will confirm the diagnosis and allow examination of the lining of your intestine to look for evidence of destruction. This exam involves inserting a camera into the intestine to retrieve a sample while you are asleep. The doctor may also supplement diagnostic testing with a genetic test.

Treatment

Unfortunately, the only long-term treatment for celiac disease is to fully avoid all foods containing gluten. A list of foods containing gluten is described in the “Causes” section. Complete gluten avoidance is difficult because gluten is found in a wide variety of foods in the typical Western diet. The Food and Drug Administration (FDA) has released guidelines governing how much gluten a product may contain if it is labeled “gluten-free” (20 parts per million of gluten) [6]. After the initial phase of treatment, oats may be slowly reintroduced into the diet. You may work with a dietitian to help guide you through which foods are appropriate in your diet.

In approximately one-fifth of patients, even a gluten-free diet fails to alleviate the symptoms. These patients may need to be treated with steroids in addition to maintaining a gluten-free diet.

Prevention

Unfortunately, there is no way to completely prevent celiac disease, except for possibly abstaining from gluten for your entire life. Some studies have shown that the timing of when a child is introduced to gluten does not affect when the child goes on to develop celiac disease, suggesting that there is no preventative measure that a parent with celiac disease can take to prevent their child from developing the disease.

When to Seek Further Consultation for Celiac Disease

You should see a healthcare professional if you are having chronic (long-term) problems that include some combination of diarrhea, constipation, pain, or nausea/vomiting that do not improve after routine measures.

References

  1. Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases. NIDDK Link

  2. Mayo Clinic Staff. Celiac disease. The Mayo Clinic. May 4, 2019. Mayo Clinic Link

  3. What is Celiac Disease? Celiac Disease Foundation. Celiac Disease Foundation Link

  4. Celiac Disease. Johns Hopkins Medicine Health Library. Hopkins Medicine Link

  5. Celiac disease. Harvard Health Publishing. Updated Feb. 7, 2019. Harvard Health Link

  6. Sources of Gluten. Celiac Disease Foundation. Celiac Disease Foundation Link