Celiac disease damages the small intestine by interfering with the absorption of nutrients from food.
People with celiac disease are unable to tolerate gluten, a protein in wheat, rye and barley. Found mainly in foods, gluten can also be present in everyday items including medicines, vitamins, lip balms and even the glue on stamps and envelopes.
Celiac disease affects each person differently. Symptoms may occur in the digestive system or in other parts of the body. One person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Irritability is one of the most common symptoms in children. Some people have no symptoms.
Although some people have no symptoms, approximately 15-25 percent have an intense itchy and blistery skin rash known as dermatitis herpetiformis (DH). It usually occurs on the elbows, knees and buttocks. Most people with DH have no digestive symptoms of celiac disease.
Diagnosis
Celiac disease is genetic. Recognizing it can be challenging as its symptoms may mimic those of other conditions. For example, it may be mistaken for irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections and chronic fatigue syndrome. However, due to increased awareness about celiac disease and more sophisticated blood tests that can help pinpoint it, diagnosis rates are increasing.
Diagnostic tests include:
Blood Tests
The most common diagnostic tool, doctors test 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, more blood tests may be needed.
Intestinal Biopsy
If blood tests and symptoms suggest celiac disease, your doctor may request a biopsy of the small intestine. This will help confirm the diagnosis. During the biopsy, the doctor removes tiny samples of tissue from the small intestine through the patient’s mouth via an endoscope.
Patients with DH are diagnosed for celiac disease through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, there is no need for an intestinal biopsy.
Treatment
The only treatment for celiac disease is a gluten-free diet. Your doctor may ask you to work with a dietitian on a gluten-free diet plan. You will learn how to read ingredient lists and identify foods containing gluten 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 3-6 months in children but may take several years in adults.
For people with DH, both the skin and the intestinal diseases also respond to a gluten-free diet. The rash can be controlled with antibiotics such as dapsone.
To stay well, all people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount can damage the small intestine.