Celiac Disease Overview
What is celiac disease?
Celiac disease is a problem some people have with foods that contain gluten. Gluten is a type of protein. It’s found in the grains wheat, barley, rye, and triticale (a wheat-rye cross).
When you have this disease and you eat food with gluten in it, the gluten triggers an immune response that is not normal. This damages the inside of your small intestine so that it can’t do a good job of absorbing nutrients from your food.
It’s important to get treatment, because celiac disease can:
- Lead to anemia.
- Lead to osteoporosis.
- Raise your risk of lymphoma.
In children, celiac disease can slow growth and weaken bones. If it isn’t treated, your child can get very sick. Call a doctor if your child is losing a lot of weight, has diarrhea, or feels weak and tired for many days for no reason.
What causes celiac disease?
Doctors don’t really know what causes the disease. Having certain genes can increase your chance of getting it. You’re more likely to have these genes and get celiac disease if a close family member has the disease.
What are the symptoms?
Symptoms of celiac disease include:
- Gas and bloating.
- Changes in bowel movements.
- Weight loss.
- Feeling very tired.
- Weakness.
These symptoms can be very mild.
Some people vomit after they eat gluten. This is more likely to happen in children than in adults.
How is celiac disease diagnosed?
Your doctor will ask questions about your symptoms and do a physical exam.
You may have blood tests to see if you have certain antibodies that could mean you have the disease.
To make sure you have celiac disease, you will probably have an endoscopy. In this test, a doctor uses a thin, lighted tube to look at the inside of your small intestine. Your doctor can also take small samples of tissue to be tested in a lab. This is called a biopsy.
Often celiac disease is mistaken for another problem such as food intolerance or irritable bowel syndrome. You may be treated for one of these problems first.
After your celiac disease diagnosis, your doctor may do more tests, such as blood tests to check for anemia. You may also have a bone density exam. These tests will help your doctor find out if you have other problems, such as osteoporosis, that can arise when you have celiac disease.
To get and stay well, you need to avoid all foods that have gluten. For many people, this means changing everything about the way they eat. This can be challenging. For help, work with a dietitian who has experience with gluten-free diets. Together you can find foods you like that don’t have gluten.
Avoid all foods made with wheat, rye, barley, or triticale. Don’t drink any beer or ale.
You can still eat eggs, meat, fish, fruit, and vegetables. Flours and foods made with amaranth, arrowroot, beans, buckwheat, corn, cornmeal, flax, millet, potatoes, pure uncontaminated nut and oat bran, quinoa, rice, sorghum, soybeans, tapioca, or teff are also okay. Within 2 weeks after starting a gluten-free eating plan, most people find that their symptoms start to get better.
For a short time after your treatment starts, you might also need to stop drinking cow’s milk and foods made with it. Most of the time, but not always, people can have these foods again after their intestine has healed.
Some foods that are labeled “wheat-free” may still have gluten. Gluten can be in things you may not expect, like medicine, vitamins, and lipstick. Be sure to read labels.
Watch out for the following phrases. They could mean that a product contains gluten:
“Modified food starch.”
“Hydrolyzed vegetable protein.”
Many people don’t know they have celiac disease. Researchers think as few as 1 in 5 people with the disease ever find out that they have it.
Damage to the intestine happens slowly, and the symptoms can vary a lot from person to person. So it can take years to get the diagnosis.
Diagnosis: What to Expect
Since celiac disease tends to run in families, if you have a parent, child, brother, or sister with the disease, talk to your doctor about whether you should be tested. Celiac disease is more common in people with type 1 diabetes, autoimmune liver disease, thyroid disease, Down syndrome, Turner syndrome, or Williams syndrome. So if you have any of these conditions, you should also ask your doctor to test you for celiac.
Gluten Needed Before Tests
You’ll need to take some tests to find out if you have celiac disease. And for some of these tests to be accurate, you’ll have to have some gluten in your diet.
If you’re on a gluten-free diet, your doctor may put you on a “gluten challenge” plan before you take these tests. You’ll eat at least two servings of gluten (four slices of bread) every day for 8 weeks.
Blood and Genetic Tests
To find out if you have celiac disease, you may first get:
Blood test. This test checks for certain antibodies in your blood. Almost everyone with celiac has them in their blood at higher-than-normal levels.
HLA genetic test. This looks for the HLA-DQ2 and HLA-DQ8 genes. If you don’t have them, it’s very unlikely that you have celiac disease. You may get a blood test, saliva test, or a swab of the inside of your cheek.
These tests aren’t enough to show that you have celiac disease. But if the results show that you might, your next step is endoscopy.
Endoscopy
This procedure lets your doctor check your small intestine for damage. She’ll insert a scope with a camera through your mouth, down your esophagus, and into your intestinal tract. Your doctor will likely take a little bit of tissue from the lining of your small intestine for further study. Doctors call this a biopsy.
In particular, your doctor will check tiny, fingerlike projections called villi on the lining of the small intestine. Damaged villi are a sign of celiac disease.
Endoscopy takes about 15 minutes and you can get it done in a doctor’s office. To find out if you have celiac disease, you must still be on a diet containing gluten when you get the endoscopy.
Your biopsy may show that you have celiac disease. If your biopsy shows that you don’t have celiac disease, but your doctor still thinks gluten is the cause of your symptoms, you might have
“non-celiac gluten sensitivity.” That means that your body doesn’t handle gluten well, even though you don’t have celiac disease.
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