Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
Celiac disease is an autoimmune disease in which foods that contain the protein gluten—found in wheat, barley, and rye—trigger your white blood cells to attack the lining of your small intestine, ultimately eroding it until it's worn smooth.
Celiac has a wide range of potential symptoms, from abdominal pain to headaches. These symptoms and intestinal damage can be largely reversed once you're diagnosed and follow a gluten-free diet—the only current treatment for the condition.
People with untreated celiac disease often cannot absorb nutrients from their food, and this can lead to serious health complications, such as malnutrition, osteoporosis, infertility, and even cancer.
The best way to be tested for celiac disease is to discuss your symptoms with a doctor. They can perform blood tests, an endoscopy, and a biopsy to look for signs. You might be tempted to test yourself at home by going gluten-free. However, this is not only difficult, it could hamper your doctor’s efforts to diagnose you, as gluten-related damage must be present for celiac to be identified.
Experts aren’t certain what causes celiac disease, but many believe it starts with a genetic potential and then requires a triggering event, such as a period of extreme stress or pregnancy. However, some people with a gradual onset might not have this kind of trigger.
Research suggests that some people have the genetic potential to develop celiac disease and it can run in families. Having a close relative who’s diagnosed with celiac increases your risk of developing it, but even having multiple relatives with the disease is no guarantee you’ll end up with it. You may learn more about your risk via genetic testing.
Celiac disease is typically diagnosed with blood tests and an endoscopy. Blood tests look for an antibody produced by the immune system of people with celiac in response to gluten’s presence in the digestive tract. In an endoscopy, a doctor uses a scope to examine your small intestine and take samples to look at under a microscope. If those samples show villous atrophy, it means you have celiac.
A lot of people refer to it as a gluten allergy, but celiac is an autoimmune disease. That means the immune system has mistakenly identified gluten in your small intestine as a threat, as if it were a virus or other pathogen. It then creates antibodies that attack the small intestine, trying to destroy the gluten. Some people are allergic to wheat, but that’s not the same thing as celiac.
Celiac can cause more than 200 symptoms all throughout your body, but the primary ones are digestive. Common symptoms include:
Symptoms can vary greatly. Some people with celiac have no symptoms at all.
Anemia is the medical term for deficiency of red blood cells or hemoglobin in the blood. The most common form, iron-deficiency anemia, is related to celiac disease because damage to the small intestine creates problems with absorbing nutrients from food. Anemia symptoms can include:
Autoimmune diseases involve a malfunctioning immune system. First, the immune system mistakes a normal tissue or substance in your body for a dangerous pathogen, like a virus, bacterium, or fungus. It then creates special antibodies to destroy that tissue or substance. In celiac disease, the antibodies’ target is the gluten you consume. More than 100 autoimmune diseases exist.
A biopsy involves the removal of cells or small amounts of tissue so they can be examined. This is a common diagnostic procedure for many illnesses, including celiac disease, but it’s probably best known in relation to diagnosing and determining the spread of cancer. When performed to diagnose celiac, biopsy is typically performed during an upper endoscopy.
Also called “gluten rash,” dermatitis herpetiformis is an extremely itchy and painful rash caused by your body’s abnormal reaction to gluten in your diet. Its fluid-filled red bumps and blisters can show up anywhere but are most common on the:
Cutting gluten out of your diet is the only way to get rid of it.
In an endoscopy, a doctor uses a device called an endoscope to look inside your body. An endoscope is a thin, flexible tube with a camera and fiber-optic light at the tip. When they suspect celiac disease, doctors will perform an upper endoscopy (through the mouth) to look for villous atrophy, which is damage to the small intestine caused by celiac.
Gluten is a protein found in almost all grains. It’s what gives dough elasticity and structure. However, only one type of gluten, which is found in the Poaceae family of grasses, causes reactions in people with celiac disease and gluten sensitivity. It’s found in wheat, barley, rye, and some oats (by cross contamination).
A gluten-free diet is a medical diet for controlling the symptoms of celiac disease and gluten sensitivity. It eliminates foods that contain gluten—a protein found in wheat, barley, rye, and some oats. This includes a wide array of foods and beverages, including:
An intestinal disease is any medical condition that impacts a segment of the small or large intestines, which are part of the gastrointestinal tract (your digestive system). Celiac disease and Crohn’s disease affect the small intestine. Ulcerative colitis and diverticulitis affect the large intestine. Irritable bowel syndrome (IBS) impacts both.
Malnutrition results from your body not getting enough nutrients. Poor diet and certain medical conditions, including untreated celiac disease, can cause malnutrition. In people with celiac, the immune system damages the lining of the small intestine, which impairs its ability to absorb nutrients. Following a gluten-free diet usually eliminates the damage and the risk of becoming malnourished.
Typically the first test performed for suspected celiac disease, the tTG-IgA test includes two measures of antibodies that can indicate the disease. tTG stands for tissue transglutaminase and IgA stands for immunoglobulin A. IgA is the most common antibody found in people with celiac.
In celiac disease, gluten causes damage to the villi of the small intestine, short projections that absorb nutrients. Explore an interactive model that shows how this damage can deepen the area between villi known as intestinal crypts, causing lesions to form on the intestine.
U.S. National Library of Medicine. Colonic diseases. Medline Plus.
U.S. National Library of Medicine. Small intestine disorders. Medline Plus.