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Celiac Disease
(Gluten Enteropathy)

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Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Bhupinder Anand, MD

Celiac disease facts

• Celiac disease is a chronic digestive disorder in which damage to the lining of the small intestine leads to the malabsorption of minerals and nutrients.
  
  
• The destruction of the inner lining of the small intestine in celiac disease is caused by an immunological (allergic) reaction to gluten.
  
  
• Gluten is a family of proteins present in wheat, barley, rye, and sometimes oats.
  
  
• Individuals with celiac disease may develop diarrhea, steatorrhea, weight loss, flatulence, iron deficiency anemia, abnormal bleeding, or weakened bones. However, many adults with celiac disease may have either no symptoms or only vague abdominal discomfort such as bloating, abdominal distension, and excess gas.
  
  
• Children with celiac disease may have stunted growth, and if untreated, childhood celiac disease can result in short stature as an adult.
  
  
• Small intestinal biopsy is considered the most accurate test for celiac disease.
  
  
• Blood tests can be performed to diagnose celiac disease; these include endomysial antibodies, anti-tissue transglutaminase antibodies, and anti-gliadin antibodies.
  
  
• There is no cure for celiac disease. The treatment of celiac disease is a gluten free diet.
  
  
• In most individuals, a gluten free diet will result in improvement in symptoms within weeks. Many individuals report symptom improvement within 48 hours.
  
  
• In children with celiac disease, successful treatment with a gluten free diet can lead to the resumption in growth (with rapid catch up in height).
  
  
• Failure to respond to a gluten free diet can be due to several reasons; the most common reason is failure to adhere to a strict gluten free diet.
  
  
• Refractory celiac disease is a rare condition in which the symptoms of celiac disease (and the loss of villi) do not improve despite many months of a strict gluten free diet. It may progress to cancer.
  
  
• The treatment of refractory celiac disease is first to make sure that all gluten is eliminated from the diet. If there still is no improvement, corticosteroids such as prednisone, and immunosuppressive agents (medications that suppress a person's immune system) such as azathioprine and cyclosporine may be used.
  
  
• Adults with celiac disease have a several-fold higher than normal risk of developing lymphomas (cancers of the lymph glands) in the small intestine and elsewhere. They also have a high risk of small intestinal and, to a lesser degree, of esophageal carcinomas (cancers of the inner lining of the intestine and esophagus).
  
  
• The prognosis of individuals with celiac disease who develop lymphoma, collagenous celiac disease, or jejunal ulcers is poor.

What is celiac disease?

Celiac disease is a disease of the small intestine. The small intestine is a 22 foot long tube that begins at the stomach and ends at the large intestine (colon). The first 10 inches (25cm) of the small intestine (the part that is attached to the stomach) is called the duodenum, the middle part is called the jejunum, and the last part (the part that is attached to the colon) is called the ileum. Food empties from the stomach into the small intestine where it is digested and absorbed into the body. While food is being digested and absorbed, it is transported by the small intestine to the colon. What enters the colon is primarily undigested food. In celiac disease, there is an immunological (allergic) reaction within the inner lining of the small intestine to proteins (gluten) that are present in wheat, rye, barley and, to a lesser extent, in oats. The immunological reaction causes inflammation that destroys the lining of the small intestine. This reduces the absorption of the dietary nutrients and can lead to symptoms and signs of nutritional, vitamin, and mineral deficiencies.

The other terms used forceliac disease include sprue, nontropical sprue, gluten enteropathy, and adult celiac disease. (Tropical sprue is another disease of the small intestine that occurs in tropical climates. Although tropical sprue may cause symptoms that are similar to celiac disease, the two diseases are not related.)

Celiac disease is common in European countries, particularly in Ireland, Italy, Sweden, and Austria. In Northern Ireland, for example, one in every 300 people has celiac disease. In Finland, the prevalence may be as high as one in every 100 persons. Celiac disease also occurs in North America where the prevalence has been estimated to be one in every 3000 people. Unfortunately, most population studies underestimate the prevalence of celiac disease because many individuals who develop celiac disease have few or no symptoms until later in life. Moreover, a study suggests that the prevalence of celiac disease in the United States is similar to that in Europe.