Celiac Disease


Celiac disease, also called nontropical sprue, gluten-sensitive enteropathy or celiac sprue, is a condition in which gluten, a protein found in wheat, barley and oats, injures the lining of the small intestine causing malabsorption of nutrients. The normal small intestinal lining consists of small projections called villi and even smaller projections called microvilli, which create an enormous surface area for absorption of nutrients. Normally, foods are digested and nutrients are absorbed into the blood stream through the villi of the small intestine. When the villi are damaged, as with celiac disease, absorption is impaired.


Symptoms are caused by the increased passage of unabsorbed nutrients through the gastrointestinal tract or by nutritional deficiencies. The severity of symptoms varies and depends upon how severe the small intestine is damaged. Weight loss, diarrhea, gas, bloating, abdominal cramping or vitamin and mineral deficiencies can occur to varying degrees. Many people have little or no symptoms at all. A small percentage of people with celiac disease develop a skin rash called dermatitis herpetiformis. Malabsorption of fats in the gastrointestinal tract often results in stool that is light colored, soft or loose and unusually foul smelling. Grease droplets may be seen in the toilet water with fat malabsorption. Inadequate absorption of sugars can cause explosive diarrhea, gas and abdominal bloating. Nutritional deficiencies can cause additional symptoms. Anemia develops as a result of iron deficiency and may cause fatigue and weakness. Vitamin B12 deficiency can also contribute to anemia and also lead to nerve damage. Malabsorption of calcium can result in abnormal bone growth, osteoporosis, painful bones and joints and a higher risk of broken bones, as well as tooth discoloration and tooth decay. Protein malabsorption can lead to fluid retention and tissue swelling.


A blood test that measures specific antibodies produced when a person with celiac disease consumes gluten can be helpful in diagnosis. A small intestinal biopsy is needed to definitively establish a diagnosis of celiac disease. A small intestinal biopsy is obtained during upper GI endoscopy, which involves passing a camera into the small bowel to obtain biopsies.


Gluten must be completely eliminated from the diet in patients with celiac disease. Once gluten is avoided, the small intestine heals and its absorptive function returns to normal. Removing gluten from the diet is not easy because gluten is so widely used in food products. Expert advice from a dietician and detailed lists of foods to be avoided are crucial in treatment. The response to a gluten free diet is usually dramatic and rapid, however some patients continue to have symptoms even when gluten is avoided. In such cases, either the diagnosis is incorrect, or unknown sources of gluten are being ingested, or rarely the disease has progressed to a condition called refractory celiac disease. In refractory celiac disease, treatment with corticosteroids may help. Although most people with celiac disease do well on a strict gluten free diet, a small percent of patients can develop intestinal lymphoma, a type of intestinal cancer that can be fatal.