Doctors Who Treat Celiac Disease or Gluten Sensitivity

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Many different types of doctors potentially play a variety of different roles in diagnosing and treating you for celiac disease or for non-celiac gluten sensitivity. That's why discussing the celiac disease symptoms and/or gluten sensitivity symptoms you have with your primary care physician is a good first step to take. 

It's nearly impossible to tell the difference between the conditions from your symptoms alone, so your doctor can order the tests you'll need to determine if you have celiac disease, and can help you decide the next steps in your care.

Role of the Primary Care Doctor

If you think you're reacting to gluten in your diet, you should determine whether or not you have celiac disease. To do this, you need to have a set of celiac blood tests. Your primary care doctor can order these tests.

You need to be eating gluten for the tests to be accurate, so don't change your diet just yet. 

If you have a positive result on these blood tests, it doesn't mean you definitely have celiac disease. However, it does mean your doctor likely will refer you to a gastroenterologist—a type of doctor who specializes in conditions involving the digestive system.

Role of the Gastroenterologist

A gastroenterologist can perform an endoscopy, a procedure that's the next step in the diagnostic process for celiac disease. In an endoscopy, the gastroenterologist will use an instrument called an endoscope to take tiny samples of your small intestine.

Endoscopy involves the insertion of a flexible scope through the mouth and down the esophagus, stomach, and small intestine to obtain a tissue sample (biopsy). This is typically done on an outpatient basis.

The sample will then be sent to a pathology lab for evaluation.

Role of the Pathologist

As the final step to diagnose celiac disease, a doctor called a pathologist—a type of physician who examines tissues—will review those samples of your small intestine to look for signs of villous atrophy (a type of damage found in celiac disease involving the flattening of the finger-like lining of the intestines).

If celiac disease is diagnosed, it will be classified in order to ensure that the correct treatment is delivered. The classification system commonly used is known as the Modified Marsh Classification of Histologic Findings in Celiac Disease, designed in 1992 by medical pathologist Dr. Michael Marsh.

Follow-Up Care

If you ultimately are diagnosed with celiac disease, either your gastroenterologist or your primary care doctor (or possibly both) can provide follow-up care.

Of course, other conditions potentially can have symptoms similar to those of celiac disease. Your gastroenterologist can help you sort out the cause of those symptoms regardless of whether she ultimately diagnoses you with celiac—even if your blood tests come back negative.

If you don't test positive for the celiac disease on either the blood tests or the endoscopy, you almost certainly don't have celiac disease. However, negative results on these tests don't necessarily mean you don't have a problem with gluten—you may have non-celiac gluten sensitivity instead.

Non-celiac gluten sensitivity means just what it sounds: you don't have celiac disease (because the testing was negative), but you still react to gluten (as evidenced by the fact that you feel better when you eat gluten-free, and you feel worse when you add gluten-containing foods back into your diet).

While celiac disease may benefit from the oversight of a gastroenterologist (at least until symptoms are fully under control), non-celiac gluten sensitivity can be treated either by your primary care physician or a gastroenterologist.

Unfortunately, right now there are no tests universally accepted to determine if someone has gluten sensitivity, although there are a few options you might want to discuss with your doctor. In most cases, people determine they have gluten sensitivity by cutting out gluten and then reintroducing it while watching for a reaction.

Other Medical Specialists

Regardless of whether you have celiac disease or gluten sensitivity, you may wind up needing care from different medical specialists, depending on the associated symptoms you may have.

For example, you may need a neurologist to deal with recurrent migraine, a dermatologist to treat eczema or dermatitis herpetiformis, or an endocrinologist if you are struggling with infertility or diabetes.

These conditions seem to be common in people with celiac disease and gluten sensitivity and may be better treated by a physician who specializes in those specific areas.

You may also need assistance from a dietitian who can help you embark on a gluten-free diet. A dietitian is not a doctor but is a vital part of the care team if you've been diagnosed with celiac disease or non-celiac gluten intolerance.

A Word From Verywell

It's not unusual to work with several doctors, especially at first as you're in the process of obtaining a diagnosis.

Once you're feeling better and you've mastered the gluten-free diet, you may find you only need one doctor to help manage your care. This doctor may be your primary care physician or possibly your gastroenterologist and will be able to make any referrals for follow-up care from specialists that you need in the future.

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Article Sources

  • National Institute of Diabetes and Digestive and Kidney Diseases. How Do Doctors Treat Celiac Disease? fact sheet.