Understanding Celiac Disease

Published date: March 15, 2012 | Modified date: April 2, 2019

What is celiac disease?

Celiac disease is an autoimmune disorder where ingesting gluten leads to damage in the small intestine. This is a very specific type of damage called villous atrophy. Villi are microscopic finger like extensions that line the surface of your small intestine.

Together, the villi create thousands of folds along the lining of the small intestine, which serve to vastly increase the surface of the small intestine. Without them we cannot properly digest food, nor can we properly absorb the nutrients from our food.

How prevalent is celiac disease?

The occurrence of celiac disease is much higher than previously thought. Many studies have been done, and approximately 1 in 100 people have celiac disease. This is relatively consistent around the world.

What are symptoms of celiac disease?

The symptoms of celiac disease vary. Often, the condition causes diarrhea, abdominal pain, gas, and bloating. Other symptoms include constipation, weight loss, weight gain, fatigue, headaches, heartburn, skin problems such as eczema and acne, joint pain, and more.

It is important to recognize that may people who have celiac disease experience no discernable symptoms.

How do doctors diagnose celiac disease?

Celiac disease can be diagnosed by an upper endoscopy, small intestine biopsy, or blood test. Celiac disease has been most commonly diagnosed by gastroenterologists.

When performing an upper endoscopy, which means putting a cable with a scope into your mouth and down into your stomach, these doctors are able to see into the very upper part of the small intestine.

Celiac disease cannot be diagnosed solely with a visual examination of the small intestine, but while there, they can take a small tissue sample of the lining of the small intestine. This is called a biopsy. This tissue sample is sent to a pathologist, who looks at the sample under the microscope. If the biopsy is positive for celiac disease, it will show damage to the intestine known as villous atrophy.

Biopsies are done on an outpatient basis but require strong medication due to the invasive nature of the procedure. Celiac disease can also be diagnosed with a blood test.

What are the blood tests for celiac?

There are several different types of blood test to diagnose celiac disease, and all involve the measurement of antibodies. The most common blood tests for detecting celiac disease measure tissue transglutaminase antibodies and deamidated gliadin antibodies.

Both IgA and IgG tissue transglutaminase and deamidated gliadin antibodies should be measured. (Note: Deamidated gliadin antibodies should not be confused with gliadin antibodies, which is a different test.)

Endomysial antibodies and reticulin antibodies are older blood tests that are not as reliable as newer blood tests, but if these tests are positive, then they are also diagnostic for celiac disease.

A majority of people with a gluten allergy or celiac disease can be diagnosed as being allergic to gluten with blood tests alone. The results of the biopsy do not change the form of treatment nor the outcome for the patient. Only if the blood tests are negative can a biopsy potentially provide useful additional information.

What causes celiac disease?

An autoimmune reaction triggered by the ingestion of gluten causes celiac disease. At some point, the body’s immune system may begin to recognize gluten as a foreign substance that must be eradicated rather than recognizing it as nutrition.

The reaction can begin as early as birth but we do not know why this autoimmune reaction is triggered.

Gluten is found in many of the most common foods eaten in western culture. Gluten is a protein found in wheat, barley, rye, spelt, kamut, farro, triticale, and couscous. People who have celiac disease cannot eat any foods made out of these grains or any foods that contain any derivatives from these grains, because it will trigger their autoimmune reaction.

Because gluten is found in wheat, and wheat is used in a huge number of foods, gluten is therefore in most breakfast cereals, pastas, breads, crackers, cookies, muffins, cakes, soy sauce, pancakes, waffles, soups, and gravies. It is also found in many other foods. And beer, ale, lager, and stout contain gluten.

What is the treatment for celiac disease?

The treatment for celiac disease is to completely stop eating gluten. There are no acceptable alternatives to this treatment. Avoiding gluten is easier said than done, but many thousands of people find they are capable of completely removing gluten from their diet.

Of course, removing gluten does take conscious effort. Many companies now produce gluten free alternatives, and more are coming out all the time. The market for gluten free foods is now well over $1 billion per year.

What is the long-term outcome for people with celiac disease?

Fortunately, removing gluten from the diet usually reverses the damage that is caused in celiac disease. Patients usually notice significant improvement within weeks if not days. Continued improvement and healing may go on for 1-2 years.

What are the differences between celiac disease and gluten intolerance?

Celiac disease is a specific type of damage that results in the small intestine. This damage is known as villous atrophy. It is caused by a reaction to gluten, which is a protein found in wheat and several other grains.

Those with celiac disease are defined as being gluten intolerant. Unfortunately, this has led to the misconception that without celiac disease you cannot be gluten intolerant. However, there are far more people who are gluten intolerant than have celiac disease. They do not have villous atrophy, but they do have a reaction to gluten.

Another misconception about celiac disease is that it is much more severe than other types of gluten reactions. The facts do not support this belief, and celiac disease is not a more severe form of gluten intolerance. Celiac disease simply means the inclusion of one symptom, the villous atrophy.

A diagnosis of celiac disease is not based on how sick you feel or on how many symptoms you have. The only thing that identifies whether or not you have celiac disease is the presence of villous atrophy, so celiac disease is a symptom of gluten intolerance.

Does gluten intolerance lead to celiac disease?

Some people have the misconception that celiac disease is the end stage of gluten intolerance. There is no evidence to suggest this, much less prove it.

Studies have clearly shown many celiacs do not suffer from any noticeable health effects and have no idea that they have celiac disease.

It is well understood that celiac disease can affect people of any age. Therefore, you may develop villous atrophy as a young child, or maybe not until you are 70 years old. It does not follow a logical pattern of progression.

Can celiac disease cause bone loss?

The short answer is yes, celiac disease is known to be associated with low bone density. Why this happens is more complicated than first thought. Scottish researchers published a study about the relationship between celiac disease and bone density.

They looked at 15 celiac patients and found three of them had an autoimmune reaction against a bone protein called osteoprotegerin. This means their own immune system was attacking their bone.

Prior to this study, researchers commonly thought low bone density in celiac disease was due to the malabsorption of nutrients required to build bone. Although this still plays an important role the development of osteoporosis, it is not the only factor.

Few people appreciate the role of the immune system in building healthy bone, but more research will likely come out regarding this relationship.

Can celiac disease cause migraines?

Headaches, including migraines, are known to be found more frequently in celiac patients. Any food has the potential to trigger a migraine if you happen to be allergic to that food. Immune system activation, such as through food allergies, can cause migraines.

Can celiac disease damage teeth?

Tooth damage is one of the common signs of celiac disease. Damage to teeth is more common in celiac disease patients who have not gone gluten-free. It may be the most common symptom in patients who say they are symptom free.

People who have bad looking teeth and dental enamel defects should consider gluten intolerance and celiac disease as a possible cause.

Dentists sometimes disregard or are unaware of this symptom and just say a patient has bad teeth. Unfortunately, going gluten-free does not reverse damage to teeth.

Is celiac disease linked to anemia?

Some patients note that fatigue is their only symptom of celiac disease. Anemia is a common cause of fatigue, and people with celiac disease have a much higher risk for developing anemia.

Interestingly, a study published in an issue of Clinical Gastroenterology and Hepatology showed celiac patients with anemia had worse looking damage in their small intestine than did those with diarrhea.

Patients who presented with anemia also were more likely to show reduced bone mineral density at the time of diagnosis.

Is celiac disease linked to heart disease?

People with celiac disease have a higher risk of heart disease, even when other factors such as weight and cholesterol are lower than normal for heart disease. The cause is likely linked to inflammation. Celiac disease is an inflammatory condition, as is heart disease.

What are other celiac disease complications?

According to the Celiac Disease Foundation, several long-term health conditions have been linked to undiagnosed or untreated celiac disease.

  • Infertility or miscarriage
  • Lactose intolerance
  • Vitamin and mineral deficiencies
  • Nervous system disorders
  • Pancreatic insufficiency
  • Intestinal lymphomas and other GI cancers (malignancies)
  • Gall bladder malfunction
  • Neurological manifestations, including ataxia (problems with balance), epileptic seizures, dementia, migraine, neuropathy, myopathy and multifocal leukoencephalopathy

Is celiac disease genetic?

There is a genetic component to celiac disease, meaning it runs in families. If you have a parent, sibling, or child with celiac disease, you have a greater chance of developing it.

Is celiac disease curable?

There is no known cure for celiac disease other than the complete avoidance of gluten. It is interesting to note that although this may not be considered a cure by everyone, it is infinitely more effective than any other known treatment for any other autoimmune disease.

Can celiac disease kill you?

It has been well established that celiac disease increases you risk for numerous cancers, dementia, other autoimmune disorders, heart disease, and has a significant impact on the absorption of nutrients.

It won’t kill you immediately, but it could certainly shorten your life.

Can celiac disease cause weight gain?

Many people associate celiac disease with weight loss, not weight gain. However, there are known cases of weight gain associated with celiac disease.

Can celiac disease cause liver problems?

Liver abnormalities are relatively common in celiac disease. Liver damages reverses to normal after treatment with a gluten-free diet in most patients. Unexplained elevations in liver enzymes, sometimes called celiac hepatitis, is the most frequent presentation of liver injury in celiac disease.

Celiac disease may also be associated with severe forms of liver disease.

Can celiac disease be reversed or go into remission?

The only way to reverse celiac disease is to avoid gluten. There is no known way to reverse celiac disease and continue to ingest gluten.

There are rare cases of people who appear to go into remission and be able to eat gluten, but these cases are extremely rare.

What causes celiac disease to develop?

Celiac disease is primarily a genetic condition. However, there are other factors that trigger the development of celiac disease.

We do not understand these well, but it is likely that anything else that negatively impacts the health of the body and stresses the immune system will increase the risk of developing celiac disease.

How does celiac disease affect fertility?

Celiac disease affects the absorption of nutrients, which may affect fertility through a variety of mechanisms, including the production of hormones. It also causes inflammation, which may impact fertility.