Celiac Disease

The main risk factor is having a family member with celiac disease. The disease can affect anyone, but it tends to be more common in those with existing autoimmune diseases (e.g., autoimmune liver disease, type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease).

What are the symptoms of celiac disease?

Symptoms of celiac disease can vary from person to person and can occur in your digestive system or in other parts of your body. Symptoms may first appear after an episode of gastroenteritis, severe emotional distress, abdominal surgery, pregnancy or childbirth. They can include:

• Bloating, gas or abdominal pain
• Constipation or diarrhea
• Significant unexplained weight loss
• Chronic fatigue and weakness
• Unexplained anemia
• Premature onset of osteoporosis
• Itchy skin rash with small blisters or mouth ulcers
• Irritability or behavior change
• Tingling or numbness in hands or feet
• Migraine headaches

How is celiac disease diagnosed?

Several blood tests are available to screen for celiac disease. The main test is the tTG-IgA test, which measures certain antibodies in your blood. If the results are positive, or if the clinical picture suggests celiac disease, your clinician may recommend an upper endoscopy to get a biopsy from your small intestine.

Up to 10 percent of people with celiac disease can register a “false” normal level of tTG IgA. Therefore, an endoscopy and biopsy offer more definite results.  

What do I need to do to prepare for testing?

Clinicians recommend not starting a gluten-free diet before you are diagnosed. The damage to the small intestine caused by gluten is reversible, and eliminating gluten from your diet before the biopsy is performed can interfere with an accurate test. Similarly, your antibody levels will decline once a gluten-free diet is started, making the blood tests less accurate in diagnosing celiac disease.

It can take a year or two before antibody levels return to normal. Therefore, we suggest having a follow-up biopsy as soon as possible after seeing your clinician and starting a gluten-free diet.

How is celiac disease treated?

Currently, treatment for celiac disease involves a lifelong gluten-free diet. This means strictly avoiding wheat, barley and rye, and any food, drinks and medications that contain gluten. While following this diet may be challenging, it’s important to restoring your health and improving quality of life.

Conditions that mimic celiac disease

There are other digestive conditions that can cause symptoms from eating wheat and other grains and starches. These conditions are treated differently than celiac disease and include:

Non-celiac gluten sensitivity (NCGS)

A condition with digestive symptoms similar to celiac disease, NCGS does not cause intestinal damage or anemia, and your IgA antibodies are not typically elevated. NCGS can show itself as sensitivity to small amounts of gluten. There are no diagnostic tests for this condition; however, in a blood test, the absence of the celiac disease susceptibility HLA-DQ genes would rule out celiac disease.

Wheat starch intolerance

If you are intolerant of, or sensitive to, wheat, like those with irritable bowel syndrome (IBS), you may be reacting to wheat starch, which can be fermented by bacteria in the intestines. If you have IBS and are sensitive to fermentable sugars and starches, you may have symptoms such as bloating, excessive gas, digestive complaints or altered bowel habits.

Small intestinal bacterial overgrowth (SIBO)

Overgrowth of friendly bacteria in your small intestine can also cause intolerance of wheat and other starches. SIBO can cause several digestive problems, from food intolerances and diarrhea to abdominal pain, bloating and excessive gas.

In more severe cases, you may experience weight loss, anemia and nutritional deficiencies. The more severe forms of SIBO typically occur in elderly people, after gastrointestinal surgery, and in those who have altered motor function of the digestive tract. However, SIBO can occur even if you have a seemingly normal digestive tract, as well as if you have IBS, celiac disease and inflammatory bowel disease (IBD).

How are wheat starch intolerance and IBS treated?  

You can alleviate symptoms of wheat starch intolerance and IBS by following a low FODMAP diet. A low FODMAP diet consists of avoiding or limiting intake of certain carbohydrates that can be found in many natural and processed foods.