Sprue; Nontropical sprue; Gluten intolerance; Gluten-sensitive enteropathy
People with celiac disease, also called celiac sprue, can't eat a protein called gluten that's found in bread, pasta, and other foods because it damages their small intestine. In people with celiac disease, gluten triggers an immune reaction that damages the tiny, finger-like projections called villi, which help your intestines absorb nutrients. The villi become flattened and do not work as well, so nutrients leave your body as part of your stool instead of being absorbed. Eventually you can become malnourished and deficient in the vitamins and nutrients you need to stay healthy.
Gluten is found in wheat, barley, rye, spelt, kamut, and possibly oat products. Some vitamins and medicines also contain gluten. Many processed foods contain gluten in different forms under misleading names, like "modified food starch."
People with celiac disease must learn about all sources of gluten and read food labels thoroughly. You can develop celiac disease at any age. Although there is no cure, you can control symptoms by eating a gluten-free diet.
Signs and Symptoms
The symptoms of celiac disease can vary from person to person. For example, one person may have constipation, another may have diarrhea, and yet a third may have no intestinal problems at all.
A partial listing of gastrointestinal symptoms:
- Abdominal pain
- Bloating, gas, indigestion
- Diarrhea, ongoing or occasional
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or "fatty"
Some nonintestinal symptoms:
- Joint pain
- Growth delay in children
- Irritability and changes in behavior
- Mouth ulcers
- Muscle cramps
- Unexplained short stature
- Skin problems
- Unexplained weight loss, although people can be overweight or of normal weight when diagnosed
Researchers do not know the exact cause of celiac disease. Celiac disease sometimes runs in families, and people who have a family history of celiac disease are at greater risk for developing the condition. It is most common in Caucasians and those of European ancestry. Women have it more often than men.
If someone in your immediate family has celiac disease, you have a 5 to 15% chance of getting it as well. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy, or childbirth.
You will probably be referred to a gastroenterologist (a digestive system specialist) for a diagnosis. Your health care provider may use blood tests to see if you have certain antibodies, proteins that are part of your immune system that tend to be higher than normal in people with celiac disease. They include:
- Anti-gliadin (AGA)
- Anti-tissue transglutaminase (tTGA)
- IgA anti-endomysium antibodies (AEA)
To confirm the diagnosis, your doctor may use an endoscope, a small, flexible tube with a camera, to look into your small intestine and take a sample of tissue (biopsy).
A complete blood count (CBC) may indicate anemia. If anemia is detected, it is important to determine the cause.
Other tests may show whether you have bone loss, malabsorption, or malnutrition.
Your provider may order a follow-up biopsy or blood work several months after the diagnosis and treatment. These serve as a final confirmation of the disease.
Although a gluten-free diet is the treatment for celiac disease, it is important not to start a gluten-free diet before you see your health care provider for diagnosis. Eating such a diet may cause your blood tests and biopsy to look normal.
No one knows how to prevent celiac disease. However, knowing if you are at higher risk, such as having a family member with celiac disease, may increase the chance of early diagnosis and treatment.
In the United States, people without symptoms are not routinely screened for celiac disease.
Antibody screening tests may not be reliable in young children.
You will need to eat a gluten-free diet for the rest of your life, to protect your intestines.
Completely eliminate foods, beverages, and medications that contain wheat, barley, rye, and possibly oats. Grains that are gluten free when grown include buckwheat, quinoa, and amaranth. However, they may be contaminated with gluten when they are processed, so check labels carefully to make sure they say "manufactured in a gluten-free facility."
Even a small amount of gluten may damage your intestine, even if it does not cause any symptoms. That is why sticking to the diet is so important.
Read food and medication labels carefully to look for hidden sources of gluten. Since wheat and barley grains are found in many places in the American diet, the treatment is challenging but can be done with education and planning. More stores and even restaurants are beginning to offer gluten-free foods.
DO NOT start a gluten-free diet before seeking a diagnosis for celiac disease. Doing so will make it hard for your doctor to test you for the disease. If you are not able to absorb enough of some vitamins and nutrients, your doctor may prescribe vitamin and mineral supplements. Occasionally, doctors may prescribe corticosteroids, such as prednisone, for short-term use or if you have refractory sprue.
Following a well-balanced, gluten-free diet is generally the only available treatment to relieve symptoms of celiac disease. Several studies have also found that sticking to such a diet helps reduce the risk of intestinal lymphoma.
After you are diagnosed, you may want to talk with a registered dietitian who specializes in celiac disease and the gluten-free diet. Joining a local and national support group can also help you cope with the disease and diet. Although the diet is restrictive, you can still enjoy many foods that are gluten-free:
- Meat, poultry, fish (not with breading or marinated)
- Flours made from rice, soy, potato, or corn
See also: Nutrition
Removing all gluten from your diet is the most important thing you can do to stay healthy. If you follow a gluten-free diet for the rest of your life, you can expect to lead a long, healthy life, as long as permanent damage did not occur before diagnosis.
Left untreated, celiac disease can cause life-threatening complications. A delayed diagnosis or failure to follow the diet puts you at risk for developing other conditions.
Complications can include:
- Osteoporosis or osteomalacia, softening of the bone
- Dermatitis herpetiformis, a burning, itching, blistering rash
- Intestinal cancer. Intestinal lymphoma is up to 40 times more common in people with celiac disease than in those without the disease.
- Nerve damage, or peripheral neuropathy
- Lactose intolerance
- Thyroid disease
Untreated pregnant women with celiac disease may be at higher risk of having a miscarriage or a baby born with birth defects, such as neural tube defects, because they may not be able to absorb the nutrients they need. Preliminary studies also suggest that children of mothers and fathers with celiac disease are at greater risk of birth defects.
AGA Institute. AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease. Gastroenterology. 2006 Dec;131(6):1977-80.
Catassi C, Fabiani E, Iacono G, et al., A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007 Jan;85(1):160-6.
Cosnes J, Nion-Larmurier I. Complications of celiac disease. Pathol boil (Paris). 2013;61(2):e21-6.
De Palma G, Nadal I, Collado MC, Sanz Y. Effects of agluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 2009 Oct;102(8):1154-60
Diamanti A, Capriati T, Bizzarri C, et al. Autoimmune diseases and celiac disease which came first: genotype or gluten? Expert Rev Clin Immunol. 2016;12(1):67-77.
Drut R, Cueto Rua E. Histopathologic diagnosis of celiac disease in children without clinical evidence of malabsorption. Int J Surg Pathol. 2007 Oct;15(4):354-7.
Freeman HJ. Celiac disease and selected long-term health issues. Maturitas. 2012;73(3):206-11.
Harris L, Park J, Voltaggio L, Lam-Himlin D. Celiac disease: clinical, endoscopic, and histopathologic review. Gastrointestinal Endoscopy. 2012;76(3).
Heikkila K, Pearce J, Maki M, Kaukinen K. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(1):25-34.
Hellekson K. AHRQ Releases Practice Guidelines for Celiac Disease Screening. Am Fam Physician. May 1, 2005;71(9);1814-9.
Holm K, Maki M, Vuolteenaho N, et al., Oats in the treatment of childhood coeliac disease: a 2-year controlled trial and a long-term clinical follow-up study. Aliment Pharmacol Ther. 2006 May 15;23(10):1463-72.
Hopper AD, Hadjivassiliou M, Butt S, Sanders DS. Adult coeliac disease. BMJ. 2007 Sep 15;335(7619):558-62.
Lasa JS. Zubiaurre I, Soifer LO. Risk of infertility in patients with celiac disease: a meta-analysis of obervational studies. Arq Gastroenterol. 2014;51(2):144-50.
Lebwohl B, Spechler SJ, Wang TC, Green PH, Ludvigsson JF. Use of proton pump inhibitors and subsequent risk of celiac disease. Dig Liver Dis. 2014;46(1):36-40.
Leeds JS, Horoldt BS, Sidhu R, et al., Is there an association between coeliac disease and inflammatory bowel diseases? A study of relative prevalence in comparison with population controls. Scand J Gastroenterol. 2007 Oct;42(10):1214-20.
Leffler DA, Edwards George JB, et al., A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease. Aliment Pharmacol Ther. 2007 Nov 1;26(9):1227-35.
Lohi S, Mustalahti K, Kaukinen K, et al., Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25.
Malamut G, Cellier C. Clinical manifestations of adult celiac disease. Pathol Biol (Paris). 2013;61(3):e47-51.
Ojetti V, Gabrielli M, Migneco A, et al., Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet. Scand J Gastroenterol. 2007 Oct 5:1-4.
Rashid M, Butzner D, Burrows V, et al., Consumption of pure oats by individuals with celiac disease: A position statement by the Canadian Celiac Association. Can J Gastroenterol. 2007 Oct;21(10):649-51.
Rossi T. Celiac disease. Adolesc Med Clin. Feb 2004;15(1): 91-103, ix.
Schuppan D, Junker Y, Barisani D. Celiac disease: from pathogenesis to novel therapies. Gastroenterology. 2009 Dec;137(6):1912-33. [Epub ahead of print].
Sollid LM, Lundin KE. Diagnosis and treatment of celiac disease. Mucosal Immunol. 2009 Jan;2(1):3-7.
Srinivas M, Basumani P, Podmore G, Shrimpton A, Bardhan KD. Utility of testing patients, on presentation, for serologic features of celiac disease. Clin Gastroenterol Hepatol. 2014;12(6):946-52.
Steroldal K, Haugen M, Brantsaeter AL, Lundin KE, Stene LC. Association between maternal iron supplementation during pregnancy and risk of celiac disease in children. Clin Gastroenterol Hepatol. 2014;12(4):624-31.e1-2.
Virili C, Bassotti G, Santaguida MG, et al. Atypical celiac disease as cause of increased need for thyroxine: a systemic study. J Clin Endocrinol Metab. 2012;97(3):E419-22.
Zugna D, Richiardi L, Stephansson O, et al. Risk of congenital malformations among offspring of mothers and fathers with celiac disease: a nationwide cohort study. Clin Gastroenterol Hepatol. 2014;12(7):1108-16.e6.
Review Date: 2/2/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.