Celiac Disease
(Gluten Enteropathy)

Gluten-Free Diet Slideshow

Medical Author: Dennis Lee, M.D.
Medical Editor: Jay W. Marks, M.D.

• What is celiac disease?
• What causes celiac disease?
• What does celiac disease do to the small intestine?
• What are the signs and symptoms of celiac disease?
• How do symptoms of celiac disease differ with age of onset?
• What is latent and silent celiac disease?
• What diseases are associated with celiac disease?
• How is celiac disease diagnosed?
• Who should undergo antibody blood tests for celiac disease?
• Why is it important to accurately diagnose celiac disease?
• How are malabsorption and malnutrition evaluated in celiac disease?
• What is the treatment of celiac disease?
• What if patients fail to respond to gluten free diet?
• What is refractory celiac disease?
• What is the treatment for refractory celiac disease?
• What are the complications of celiac disease?
• Can cancer risk be reduced in celiac disease?
• What's new in celiac disease?
• Celiac Disease At A Glance
• Information on gluten free diet
• Pictures of Gluten-Free Diet - Slideshow
• Patient Discussions: Celiac Disease - Symptoms at Onset of Disease

Featured hemorrhoids celiac disease discussions on symptoms at the onset of your disease "My symptoms at onset of the disease were loss of bone density, loss of muscle mass, 0% body fat, dermatitis herpetiformis, depression, muscle weakness, weight loss, diarrhea, daily vomiting, iron-deficient anemia, low calcium and vitamin D counts, B-12 and Vitamin K anemia, headaches, urticaria and fatigue. I was 21 when diagnosed, and had these symptoms for 6 years, escalating in severity. I was diagnosed by a collective team in the hospital after having full body muscle spasms that were mistaken for epileptic seizures. The gluten-free diet has cleared all of the symptoms and improved my overall mental and physical health! " "I had intestinal symptoms for years and years (gas, diarrhea, abdominal cramping), but wasn't diagnosed with celiac disease until I broke out with dermatitis herpetiformis all over my body at about age 50. " "I was diagnosed with IBS 22 yrs ago and I have been hospitalized three times with bad bouts of diarrhea and only told I had to learn to live with it. March this year I got an appointment to go for a scan and I casually asked the nurse attending why I was having this scan and she said to me that I was newly diagnosed with celiac disease which was news to me. Since I have been on a gluten free diet I have been feeling much better I have had a few setbacks, but nothing near like what I was like when I was undiagnosed. I just wished that I could have been told earlier and I could have had a better quality of life as I was often very ill. " Read All Comments on Celiac Disease » Top Searched Celiac Disease Terms: gluten free diet, symptoms, celiac sprue, in children, malabsorption symptoms, diagnosis, short stature, type 1 diabetes, lymphoma, gout, gluten free foods, blood test, ibs Patient Discussions are not a substitute for professional medical advice, or treatment. See the disclaimer at the bottom of the comments page.

What is celiac disease?

Celiac disease is a disease of the small intestine. The small intestine is a 22 foot long tube that begins at the stomach and ends at the large intestine (colon). The first 1-1/2 feet of the small intestine (the part that is attached to the stomach) is called the duodenum, the middle part is called the jejunum, and the last part (the part that is attached to the colon) is called the ileum. Food empties from the stomach into the small intestine where it is digested and absorbed into the body. While food is being digested and absorbed, it is transported by the small intestine to the colon. What enters the colon is primarily undigested food. In celiac disease, there is an immunological (allergic) reaction within the inner lining of the small intestine to proteins (gluten) that are present in wheat, rye, barley and, to a lesser extent, in oats. The immunological reaction causes inflammation that destroys the lining of the small intestine. This reduces the absorption of dietary nutrients and can lead to symptoms and signs of nutritional, vitamin, and mineral deficiencies. Other names for celiac disease include sprue, nontropical sprue, gluten enteropathy, and adult celiac disease. (Tropical sprue is another disease of the small intestine that occurs in tropical climates. Although tropical sprue may cause symptoms that are similar to celiac disease, the two diseases are not related.)

Celiac disease is common in European countries, particularly in Ireland, Italy, Sweden, and Austria. In Northern Ireland, for example, one in every 300 people has celiac disease. In Finland, the prevalence may be as high as one in every 100 persons. Celiac disease also occurs in North America where the prevalence has been estimated at one in every 3000 people. Unfortunately, most population studies underestimate the prevalence of celiac disease because many patients who develop celiac disease have few or no symptoms until later in life. In fact, a recent study in the United States suggests that the prevalence of celiac disease in the United States is similar to Europe.

What causes celiac disease?

The destruction of the inner lining of the small intestine in celiac disease is caused by an immunological (allergic) reaction to gluten in the diet that inflames and destroys the inner lining of the small intestine. There is evidence that this reaction is partially genetic and inherited. Thus, approximately 10% of first-degree relatives (parents, siblings or children) of individuals with celiac disease also will have celiac disease. In addition, in approximately 30% of fraternal twins and 70% of identical twins, both twins will have celiac disease. Finally, certain genes have been found to be more common among individuals with celiac disease than among individuals without celiac disease.

Gluten is a family of proteins present in wheat. Some of the proteins that make up gluten (the ones that are dissolved by alcohol) are called gliadin. It is the gliadin in gluten that causes the immunological reaction in celiac disease. The mechanism whereby gliadin becomes toxic (damaging) is not clear; however, much scientific study is being done, and we are beginning to understand the mechanism.

Proteins, including gliadin, are long chains of amino acids-up to several hundred--attached to each other. Normally during digestion, digestive enzymes within the small intestine break-up proteins into single amino acids and smaller chains of amino acids. This is necessary because the intestine only can absorb single amino acids or, at most, chains of 3-4 amino acids. Single amino acids and chains of several amino acids do not cause problems for the intestine. It appears, however, that gliadin is not completely broken-up by intestinal enzymes. Several longer chains of amino acids remain intact. Somehow these larger chains enter the cells lining the intestine, perhaps because the cells are abnormally permeable (leaky) to longer chains of amino acids. Some of these longer chains are toxic (damaging) to the intestinal cells. One of the longer chains attaches to an enzyme within the cells, tissue transglutaminase. In individuals with celiac disease, the complex of the longer chain of amino acids and tissue tranglutaminase sets off an immune reaction that attacks the complex and at the same time damages the intestinal cells.

Barley and rye contain gliadin-like proteins and can cause celiac disease in genetically-predisposed individuals. Oats also contain gliadin-like proteins, but unlike barley and rye, the gliadin-like proteins in oats cause inflammation weakly and in only a few individuals who are predisposed to develop celiac disease. Rice and corn do not cause celiac disease because they do not contain gliadin-like proteins.

Celiac Disease - Symptoms at Onset of Disease

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The symptoms of celiac disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

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