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Celiac Disease – Symptoms, Causes and Treatment

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What is celiac disease?

Celiac disease is a digestive disorder resulting from an abnormal immune reaction to gluten.

Gluten, a protein found in foods such as wheat, barley, etc., prompts an immune response in people with celiac disease in the small intestine. Over time, this reaction damages the lining of the small intestine (villi) and obstructs it from absorbing certain nutrients (malabsorption). This intestinal damage frequently leads to diarrhea, fatigue, weight loss, and bloating and may also result in serious complications.

Malabsorption can affect the growth and development of children, and in adults, it can cause symptoms such as seizures and fatigue.

There is no cure for celiac disease. However, following a strict gluten-free diet can help manage the symptoms and the healing of the intestines.

What are the symptoms of celiac disease?

The signs and symptoms of celiac disease in children and adults are different. Some of the symptoms seen in children are:

Celiac disease symptoms in adults include:

  • Anemia, typically from iron deficiency
  • Depletion of bone density (osteoporosis) or softening of the bone (osteomalacia)
  • Itchy, blistery skin rash (dermatitis herpetiformis)
  • Mouth ulcers
  • Headaches and fatigue
  • Nervous system injury, as well as numbness and tingling in the feet and hands, potential problems with balance, and cognitive impairment
  • Joint pain
  • Decreased spleen functioning (hyposplenism)

The lack of ability to absorb nutrients in children can lead to:

  • Failure to thrive for infants
  • Damage to tooth enamel
  • Weight loss
  • Anemia
  • Irritability
  • Short stature
  • Delayed puberty
  • Neurological symptoms, including attention deficit hyperactivity disorder (ADHD), headaches, learning disabilities, insufficient muscle coordination, and seizures

What causes celiac disease?

In general, the body’s immune system is designed to protect itself from foreign invaders. If people with celiac disease consume foods containing gluten, their immune systems attack the intestinal lining. This leads to inflammation (swelling) in the intestines and damages the villi, which are hair-like structures on the lining of the small intestine. The villi absorb nutrients provided by food. When the villi are damaged, people will suffer from malnutrition no matter how much they eat,  due to the inability to absorb nutrients. 

What are the complications of celiac disease?

When celiac disease is left untreated, it can lead to:

  • Malnutrition
  • Weakening of the bone
  • Infertility and miscarriage
  • Lactose intolerance
  • Cancer
  • Nervous system problems

Who is at risk for celiac disease?

Celiac disease can occur due to genetic factirs , especially if the patient’s parent or sibling has celiac disease. People with the following conditions are also at the risk of developing celiac disease:

How is celiac disease diagnosed? 

The diagnosis of celiac disease starts with a physical examination and a discussion of the patient’s medical history. 

People who suffer from celiac disease frequently have high levels of antiendomysial (EMA) and anti-tissue transglutaminase (TGA) antibodies. These can be identified through blood tests . The doctor will also run various tests to aid in confirming the diagnosis. 

The blood tests include:

For people with Dermatitis herpetiformis , a skin biopsy might also aid the doctors in diagnosing celiac disease. When a skin biopsy is done, the doctor removes small pieces of skin tissue for analysis with a microscope. If skin biopsy and blood test results point to celiac disease, an internal biopsy might not be required.

In cases where blood test or skin biopsy results are indecisive, an upper endoscopy may be used to evaluate celiac disease. When an upper endoscopy is done, an endoscope is placed through the mouth and down into the small intestine. A small camera attached to the endoscope lets the doctor look into the intestines and examine for damage to the villi. The doctor may also conduct an intestinal biopsy, which involves the removal of a tissue sample from the intestines for examination.

How is celiac disease treated?

The only way to treat celiac disease is to eliminate gluten from the diet forever. The doctor will train the patient to avoid gluten while following a nutritious and healthy diet. They will also train patients to read food and product labels to spot any ingredients that contain gluten. This lets the intestinal villi to heal and start absorbing the nutrients correctly. Even though there are no celiac disease treatment options for complete cure, a gluten-free diet can help manage some or most of the symptoms. 

Celiac disease symptoms might improve within a few days of eliminating gluten from the diet. However, people should not stop eating gluten till a diagnosis is made, as premature removal of gluten can interfere with test results and result in an inaccurate diagnosis.

Dietary precautions for people with celiac disease

Following a gluten-free diet is not so easy. If people have celiac disease, they need to know about safe foods. Below are guidelines for people on the foods to eat and avoid.

The following ingredients must be avoided:

  • Wheat
  • Rye
  • Barley
  • Triticale
  • Bulgur
  • Durum
  • Semolina

The following must be avoided unless the label mentions gluten-free:

  • Beer
  • Bread
  • Cakes and pies
  • Candy
  • Cereals
  • Cookies
  • Crackers
  • Gravies
  • Imitation meats or seafood
  • Oats
  • Pasta
  • Processed lunch meats, sausages and hot dogs
  • Salad dressings
  • Sauces (including soy sauce)
  • Soups

People can eat the following gluten-free grains and starches:

  • Buckwheat
  • Corn
  • Amaranth
  • Arrowroot
  • Cornmeal
  • Flour that is made from rice, corn, soy, potatoes or beans
  • Pure corn tortillas
  • Quinoa
  • Rice
  • Tapioca

Some other foods that are healthy and gluten-free include:

  • Fresh meats, fish, and poultry that are not breaded coated, or marinated
  • Fruit
  • Most dairy products
  • Starchy vegetables including peas, potatoes, sweet potatoes, and corn
  • Rice, beans, and lentils
  • Vegetables
  • Wine, distilled liquors, ciders, and spirits

The symptoms must improve within a few days to weeks after people make the dietary modifications. In children, the intestine typically heals in three to six months. Intestinal healing in adults can take many years. Once the intestine is completely healed, the body will be able to absorb the nutrients properly.


Untreated people or those who do not respond to treatment may experience some complications of the disease. However, celiac disease is rarely dangerous, and the majority of the diagnosed people and those who avoid gluten do well.

Verified By Dr Naveen Polavarapu
MRCP (UK), FRCP(GLASGOW), CCT(GASTRO), Liver Transplant Fellow(BIRMINGHAM, UK), Hepatologist & Transplant Hepatologist, Apollo Hospitals, Jubilee Hills, Hyderabad
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