Celiac disease is manifested when the immune system reacts against certain proteins in our diet. The proteins that trigger the immune reaction are typically wheat, barley and rye. These are collectively called "gluten" and are normally considered healthy for us.  However, for people with celiac disease this is not the case and they need a gluten-free diet.

When the immune system reacts against these proteins, it causes an inflammation in the lining of the small intestine. The area of the intestine where we normally would absorb these proteins is where the immune reaction takes place causing damage to the small intestine and the fingerlike villi. The villis primary function is to help absorb nutrients.  Therefore, damage to these villi hinders nutrition.

Celiac disease is hereditary and as many as 2 Million Americans may have celiac disease although not all are diagnosed.  This is a serious debilitating disease and if untreated can lead to anemia, infertility, weak bones, skin disorders and other problems associated with lack of proper nourishment.

Symptoms:  The disease may be confused with other gastrointestinal disorders  (i.e. irritable bowel syndrome, Crohn’s disease, etc) due to how it manifests itself. Although some people with celiac disease may not feel sick or have many symptoms, most  people do have one or more of the following:  Stomach pain, gas, diarrhea, extreme tiredness, mood change, weight loss, itchy blistering skin rash, slowed growth in children.  Since many of these symptoms are common to variou other  illness, having one or more of them does not constitute a diagnosis for celiac disease.

There is no one test to date that can definitively diagnose celiac disease. Rather, there are a variety of tests that indicate the presence of the disease. Some of these are more invasive than others. A doctor can use them in conjunction with the patient's clinical history (including possibility of heredity) to arrive at a definitive diagnosis.  Another important point is that testing should be done before a change in the person's diet to ensure accuracy.  Otherwise the test results could be wrong.

Blood tests for diagnosis of celiac disease:
tTGA – Anti-tissue transglutaminase antibody. These antibodies, when elevated, can be a reliable sign of Celiac disease.
EMA – Anti-endomysium antibody. These antibodies, when elevated, can be a reliable sign of Celiac disease.
When these tests are negative, if the disease is suspected, a more invasive procedure can be recommended.  Also, if the test are inconclusive or show a person might have Celiac disease the doctor may prescribe a biopsy for confirmation.

Tissue biopsy:
Intestinal biopsy of the small intestine can be performed via endoscopy. This procedure requires preparation and is usually performed in an outpatient facility. The sample obtained is sent to the pathology laboratory for preparation and staining. A pathologist will examine the sample under a microscope to offer a diagnosis. The diagnosis is based on evidence of tissue damage to the internal lining of the intestine (loss of villi) and other characteristics commonly caused by the disease.

To date, the only treatment available for Celiac disease is a gluten-free diet.   Once you stop eating gluten the damage to the small intestine stops and the intestines heal. 

Gluten-free diet:
There are many resources for gluten-free diets, recipes, etc.  However, it is likely that once diagnosed, your doctor will refer you to a dietitian that will design a diet that is right for this disease.  In addition, the dietitian can teach you what you can and can not eat on a gluten-free diet.  Some examples follow:

Foods that normally contain gluten and must be avoided or eliminated are:

  • Wheat einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
  • Barley
  • Rye
  • Triticale
  • Bromated flour
  • Durum flour
  • Enriched flour
  • Farina
  • Graham flour
  • Phosphated flour
  • Plain flour
  • Self-rising flour
  • Semolina
  • White flour

In addition there are various processed foods that may contain wheat, barley or rye (when in doubt check the label for gluten-free designation or contact manufacturer).

  • Bouillon cubes
  • Potato chips
  • Candy
  • Deli meats
  • French fries
  • Gravy
  • Fish imitation
  • Matzo
  • Rice mixes
  • Sauce mixes
  • Tortilla chips
  • Soups
  • Soy sauce

The National Institute of Health and the American Dietetic Association are excellent sources for more materials and complete nutrition guides for Celiac Disease.

Drawing showing villi inside small intestine

Small Intestine showing Villi
Credit: NIH