symptoms of celiac disease

Villous atrophy is a sign of celiac disease. Villi are small finger-like extensions of the lining of the intestine that are visible only under the microscope.

Celiac disease is a hereditary allergy to gluten that results in damage to the small intestine.

Common symptoms include loose stools, fatigue, weight loss and generally poor health. However, symptoms can vary widely and include constipation, weight gain, and a skin condition called dermatitis herpetiformis.

What Is Gluten? 

Gluten is a protein found in wheat, barley, and rye. Gluten is responsible for the springiness and stretchiness of bread. Without it, bread turns out heavy and dense.

How Is Celiac Disease Diagnosed? 

Celiac disease can be assessed by blood tests or by a biopsy of the small intestine performed during an upper endoscopy. The blood tests include the tissue transglutaminase antibody test and the newer deamidated gliadin antibody test. The endomysial antibody test is older and is not as senstive as the newer tests.

How Common Is Celiac Disease? 

The occurrence of celiac disease is much higher than previously thought. A recent study put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.

How Is Celiac Disease Different from a Gluten Intolerance? 

Although celiac disease is a gluten allergy, it is only one form of gluten allergy. Many react to gluten and may have elevated serum antigliadin antibodies, but they do not have damage to the small intestine. These people have a negative biopsy of the small intestine, as well as negative antiendomysial antibody and tissue transglutaminase tests.

For more information on the proper testing, contact our office with questions at


Villi are small finger-like extensions of the intestinal lining which have been damaged in celiac disease.

Celiac disease is diagnosed by measuring damage to the small intestine, either by blood testing or, traditionally, with a biopsy of the small intestine.

A positive biopsy means that the villi, or small finger-like extensions of the intestinal lining, have been damaged; this is known as villous atrophy. However, recent studies have shown blood testing to be as accurate as a biopsy.

People with celiac disease will show a marked reduction in their villi, almost as if the villi have been worn off. Damage to the villi causes a dramatic reduction in the surface area of the small intestine, resulting in both poor digestion and the poor absorption of many nutrients.

Celiac disease is not the only form of gluten intolerance or allergy. Many people react to gluten by producing elevated IgG antibodies to gluten or wheat, but they do not have damage to the small intestine. Their test results for celiac disease are negative. They become quite frustrated with traditional medicine, with its narrow focus on celiac disease, because they are told that their negative test results meant that they are not allergic or intolerant to wheat, barley, or rye. Yet when they eat a piece of bread they become sick.


Villi are tiny finger-like extensions of the surface of the intestinal tract. (image thanks to

What is celiac disease?
You may have never heard of celiac disease, but it is actually a fairly common problem. In fact, 1 out of every 133 people has it. That is over 2 million people in this country. It is really more of an allergy than a disease, although it is typically called an intolerance to gluten.

What is gluten?
Gluten is a protein found in wheat, barley, rye, spelt, kamut, triticale, and couscous. People who have celiac disease cannot eat any foods made out of these flours. Gluten is the thing that makes bread, well, bread. It allows bread to rise and keeps it together with lots of nice little air pockets, making your bread light and spongy. Without gluten it is difficult to make bread that is not heavy and dense.

What are the symptoms of celiac disease?
The symptoms vary widely. Celiac disease is typically thought of as a condition that causes diarrhea, abdominal pain, gas and bloating. However, many people do not experience these symptoms at all. They may experience constipation, weight gain, fatigue, headaches, heartburn, skin problems such as eczema and acne, or any number of health problems.

What exactly happens to the body in celiac disease?
In people with celiac disease, eating gluten leads to damage of the small intestine. Damage is specifically done to the villi of the small intestine. Villi are tiny finger-like extensions of the surface of the intestinal tract. They can only be seen under a microscope. In celiac disease the villi are in essence worn down, or blunted. This is known as villous atrophy. It’s something like the difference between holding your hand open with your fingers out, and having your hand clenched into a fist. The fist represents the blunted villi.

Why does this happen?
In people with celiac disease, their immune system is triggered by gluten to not only attack gluten, but to attack their own intestinal tract. This leads to villous atrophy. It is not known exactly why this happens, but it appears to be a genetic response to gluten.