Celiac disease is a problem some people have with foods that contain gluten. Gluten is a kind of protein found in foods like bread, crackers, and pasta. With celiac disease, your immune system attacks the gluten and harms your small intestine when you eat these kinds of foods. This makes it hard for your body to absorb nutrients that keep you healthy.
Gluten comes from grains like wheat, barley, rye, and triticale. It’s important to get treatment, because celiac disease can lead to iron deficiency anemia and osteoporosis. It can also raise your risk of lymphoma.
Celiac disease can slow growth and weaken bones in children. If it is not treated, your child can get very sick. Call a doctor if your child is losing a lot of weight, has diarrhea, or feels weak and tired for many days for no reason.
Doctors don't really know what causes the disease. Having certain genes can increase your chance of getting it. You are more likely to have these genes and get celiac disease if a close family member has it.
Symptoms of celiac disease include:
These symptoms can be very mild.
Some people vomit after they eat gluten. This is more likely to happen in children than in adults.
Your doctor will ask questions about your symptoms and do a physical exam. You may have blood tests to see if you have certain antibodies that could mean you have the disease. To make sure you have celiac disease, you will probably have an endoscopy. In this test, a doctor uses an endoscope—a thin, lighted tube that bends—to look at the inside of your small intestine. During the endoscopy, the doctor may take small samples of tissue to be tested in a lab. This is called a biopsy.
After your celiac disease diagnosis, your doctor may do more tests, such as blood tests to check for anemia or a bone density exam. These will help your doctor find out if you have other problems, such as osteoporosis, that can arise when you have celiac disease.
To get and stay well, you need to avoid all foods that have gluten. Do not eat any foods made with wheat, rye, barley, or triticale. Don't drink any beer or ale.
You can still eat eggs, meat, fish, fruit, and vegetables. Flours and starches made from rice, corn, buckwheat, potatoes, and soybeans are also okay. Within 2 weeks after starting a gluten-free eating plan, most people find that their symptoms have improved.
For a short time after your treatment starts, you might also need to stop drinking cow's milk and foods made with it. Most of the time, but not always, people can have these foods again after their intestine has healed.
Some foods that are labeled "wheat-free" may still have gluten. Gluten can be in things you may not expect, like medicine, vitamins, and lipstick. Be sure to read labels. Those with "modified food starch" or "hydrolyzed vegetable protein" may contain gluten.
Frequently Asked Questions
Learning about celiac disease:
Living with celiac disease:
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|Celiac Disease: Eating a Gluten-Free Diet|
Although the exact cause of celiac disease is not known, having certain genes increases your risk. You are more likely to have these genes and may get celiac disease if you have a first-degree relative (mother, father, brother, sister, son, or daughter) with the condition. Environmental factors, such as viral or bacterial infections, may trigger changes in the small intestine of a person with these genes. Then, eating foods that contain gluten can trigger an abnormal immune system response. Eventually, digestion and absorption problems may result.
Research continues on how genetic, environmental, and immune factors interact and affect a person's symptoms, at what age they begin, and whether long-term health problems develop.
Symptoms of celiac disease occur after eating foods containing gluten. These foods trigger an abnormal immune system response that damages the intestine. Symptoms vary widely: they may be very mild and go completely unnoticed, or they may be severe and impact daily life.
Common symptoms related to celiac disease may come and go. They include:
Celiac disease may also lead to:
Symptoms of celiac disease also occur with a variety of other conditions, which can delay the initial diagnosis.
Celiac disease is a lifelong (chronic) condition that occurs when gluten triggers an abnormal immune system response that damages the small intestine. Tiny, finger-shaped tissues (villi) line the small intestine. The villi create a large surface that absorbs vitamins, sugars, and other nutrients as food passes through the small intestine.
When a person who has celiac disease eats gluten, the villi flatten out and the intestinal lining becomes inflamed. This decreases the area in the intestine that can absorb nutrients. In some cases, the inability to absorb nutrients (malabsorption) may be severe enough to stunt growth and weaken bones. The loss of vitamins and minerals may lead to illnesses such as iron deficiency anemia, folic acid deficiency anemia, rickets, or osteoporosis.
People who have celiac disease may have periods when their symptoms seem worse. Or symptoms may sometimes not be noticed at all.
In some children, symptoms begin shortly after introducing cereal into the diet, usually after 6 months of age.
A child who has celiac disease may not grow and gain weight normally because the child's body is not absorbing needed vitamins and other nutrients. Children who have untreated celiac disease can become very ill. They may need hospitalization for treatment with fluids and medicine to restore nutrients. These treatments are usually short-term, and most children recover completely.
As children who have celiac disease grow into adulthood, they may be at a slightly increased risk for developing cancer (lymphoma) in the small intestine, the mouth, or esophagus, although the evidence for this is not clear. But studies have found that following a gluten-free diet lowers the risk for lymphoma.1 Even if a child with celiac disease does not have symptoms after eating gluten, it is critical that he or she stay on a lifelong gluten-free diet to avoid intestinal damage. You can help your teenager follow a gluten-free diet by recognizing his or her need for independence. For example, you can let your teenager plan meals and choose gluten-free foods.
Although a gluten-free diet relieves symptoms and promotes the health of the intestines, children may not reach their full height if prolonged lack of nutrient absorption stunted their growth before treatment began.
Many adults who have celiac disease do not have any symptoms, or they have only mild symptoms. Symptoms may occur at any age but most commonly develop during the 20s, 30s, and 40s.
Adults who have celiac disease have a slightly higher-than-average risk of lymphoma, which usually develops in the intestine. They also may have a slightly increased risk of developing cancer of the esophagus. Following a gluten-free diet can reduce this risk.
You are likely to get better if you consistently and permanently follow a gluten-free diet. Most people find their symptoms improve within 2 weeks of beginning a gluten-free diet. After the villi return to normal, which usually takes several months to several years, the body can absorb nutrients properly. Maintaining a gluten-free diet even when symptoms disappear is very important. Doing so usually prevents symptoms from returning and reduces the risk for complications of celiac disease, which may include lymphoma.
Symptoms usually return any time foods with gluten are eaten. Although some people who have celiac disease may be able to eat foods that contain gluten without developing symptoms, this does not mean that the body is absorbing all nutrients normally. Even without symptoms, if the small intestine is injured from gluten, the lack of absorption of nutrients may cause complications such as iron deficiency anemia and osteoporosis.
In rare cases, people who appear to have celiac disease do not get better on a gluten-free diet. Some people get better after starting a gluten-free diet and stay better for awhile, but their symptoms come back even though they are still eating a gluten-free diet. This condition is called refractory sprue. In these cases, corticosteroids or other medicines that change the immune system response may be used to control symptoms. People who do not improve on a gluten-free diet should be tested for other conditions, including T-cell lymphoma.
Celiac disease is an immune system disorder in genetically predisposed people that results in damage to the lining of the small intestine when foods with gluten are eaten. The risk for the disease may be inherited, since about 10% of first-degree relatives (mother, father, brother, sister, son, or daughter) of people who have celiac disease also develop the condition. In people who are genetically predisposed, celiac disease may be triggered by environmental factors, including viral and bacterial infections.
People who have celiac disease are also more likely than others to have:
Call a doctor if you or your child has symptoms of celiac disease. These symptoms include:
If you or your child has been diagnosed with celiac disease, call a doctor if:
If you think that you or your child may have celiac disease, watchful waiting is appropriate if mild symptoms of diarrhea or vomiting last only for a few days. Talk with a doctor if your child continues to have diarrhea and does not seem to be gaining weight as expected even though he or she has a good appetite.
If symptoms of celiac disease return after your child or you were symptom-free while following a gluten-free diet, it usually means that foods containing gluten were eaten. Try documenting your or your child's recent diet. Check food labels, looking closely for ingredients that may be sources of hidden gluten. Your local library or bookstore should have resources that can help you identify potential sources of hidden gluten. Also, a nearby hospital can usually direct you to local and national organizations that can help you follow a gluten-free diet. For more information, see the Other Places to Get Help section of this topic.
If your child has celiac disease and symptoms return, be sure to ask detailed questions about what he or she has recently eaten away from home. As children get older and more independent, they may be tempted to stray from a strict gluten-free diet. You can help your teenager follow a gluten-free diet by recognizing his or her need for independence. For example, you can let your teenager plan meals and choose gluten-free foods.
Call your doctor if you are confident that your or your child's diet is gluten-free but symptoms have returned or continue.
Health professionals who may evaluate symptoms of celiac disease in adults or children include:
A doctor who specializes in problems with the digestive system (gastroenterologist) should be consulted to confirm the diagnosis with a small intestine biopsy. In addition, a dietitian can help you plan and stay with a gluten-free diet.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
In many cases of celiac disease, other conditions with similar symptoms, such as food intolerance or irritable bowel syndrome, are first suspected. Often, celiac disease is only considered after the initial diagnosis of another condition is rejected because treatments are not effective.
A medical history, physical examination, and lab tests often point to celiac disease. The diagnosis is confirmed with a small intestine biopsy collected during an endoscopy. For this procedure, an endoscope is guided down a person's throat to the small intestine.
Tests for celiac disease should be done when you or your child is still eating a diet that includes gluten. If you have already started a gluten-free diet before these tests are done, the doctor may suggest you or your child eat a certain amount of gluten before the tests.
Celiac disease triggers the immune system to produce certain antibodies. If celiac disease is suspected, your doctor will order certain blood tests to detect and measure specific antibodies.
If your test results are positive, your doctor may perform a biopsy of the small intestine to confirm a diagnosis of celiac disease.
A biopsy taken during an upper gastrointestinal endoscopy may be done to confirm celiac disease after antibody tests are positive. Sometimes a biopsy detects celiac disease when a person is being tested for another condition.
If the biopsy shows signs of celiac disease (such as abnormal villi and inflammation in the small intestine), a gluten-free diet will be recommended. If the symptoms go away on the gluten-free diet and antibody tests are normal, a diagnosis of celiac disease is confirmed.
Other tests may be done when celiac disease is suspected. These tests may include:
If a diagnosis of celiac disease is suspected but symptoms don't improve with a gluten-free diet, further testing for other conditions and diseases, such as Crohn's disease or cystic fibrosis, may be needed.
Prepare your child for exams and tests that are needed to diagnose suspected celiac disease. Doing so will help your child understand what to expect and can help reduce fears.
Blood tests to measure antibodies, such as immunoglobulin A anti-tissue transglutaminase (IgAtTG) or the immunoglobulin A antiendomysial antibody (IgAEMA), can be useful screening tools for people who are at increased risk for having celiac disease. This includes people with a family history of celiac disease or those who have type 1 diabetes, Down syndrome, dermatitis herpetiformis, an autoimmune disease, unexplained anemia, abnormal liver function tests not caused by another disease, or unexplained osteoporosis. Talk to your doctor if you think you or your child should be screened for celiac disease.
Most people with the disease who adopt this diet permanently and consistently do not develop health problems associated with celiac disease. If nutritional deficiencies are present, other treatments may be needed, such as vitamin, iron, and calcium supplements.
When celiac disease is diagnosed, you should immediately adopt a strict gluten-free diet. Eating even the smallest amount of gluten can cause symptoms such as weight loss and diarrhea. You may be advised to temporarily avoid milk or milk products until your intestine heals, at which time you may be able to gradually reintroduce them. A registered dietitian can help you learn how to incorporate this diet and its restrictions. Most people also find local and national celiac disease support groups helpful. For more information, see the Other Places to Get Help section of this topic.
Within 2 weeks after starting a gluten-free diet, most people with celiac disease find their symptoms improve. Symptoms should completely disappear within 3 months. But it takes 2 to 6 months or longer on a gluten-free diet for the tiny, finger-shaped, raised tissues (villi) of the small intestine to return to normal.
Some children with untreated celiac disease become very sick and require hospitalization. Usually, they recover quickly after treatment with fluids and medicines. A gluten-free diet usually prevents these symptoms from returning.
A gluten-free diet usually will eliminate symptoms of celiac disease and prevent long-term damage to the small intestine or other complications.
Symptoms of the disease are controlled by adopting a gluten-free diet, but you should see a doctor yearly for monitoring. A child especially needs to be watched for:
The most common cause of recurrent symptoms of celiac disease is eating foods containing gluten. In some people, eating even the smallest amount of gluten can cause symptoms of celiac disease, such as diarrhea and weight loss. Continuing to eat gluten causes inflammation and damage to the villi in the small intestine, regardless of whether symptoms are present. Nutrients may not be absorbed properly, which can lead to long-term complications, such as weak bones or growth problems (in children). Prolonged intestinal damage may increase the risk for developing severe complications, such as lymphoma.
If you or your child experiences symptoms or complications, you may need:
Treatment for complications varies depending on the specific problems and their severity. For example, some adults may require long-term treatment for complications, such as osteoporosis.
Sometimes a person who has celiac disease does not have symptoms after eating foods that contain gluten. But damage to the small intestine is still occurring. Such damage prevents the absorption of needed nutrients, which may cause complications such as growth delays in children. The damage to the small intestine can also cause an increased risk for lymphoma in the intestine.
Following a gluten-free diet can be challenging, especially for people who do not experience symptoms. Some teenagers find it extremely difficult to consistently avoid eating foods with gluten because it makes eating out with their friends difficult. You can help your teenager follow a gluten-free diet by continuing to emphasize its importance and thinking of ways to make it as easy as possible. If you are concerned about permanently staying on a gluten-free diet, talk with your doctor.
Although celiac disease cannot be prevented, symptoms and damage to the small intestine can be reversed by maintaining a strict gluten-free diet. At first, you may also have to avoid milk and milk products. After you stop eating gluten, the intestines begin to heal and you likely will be able to gradually reintroduce milk products into your diet without triggering symptoms.
Some adults with celiac disease have a poorly functioning or nonfunctional spleen, which is a risk factor for developing a pneumococcal infection. For this reason, your doctor may recommend that you get immunized with the pneumococcal vaccine(What is a PDF document?).
Having celiac disease means that you will need to follow a gluten-free diet for the rest of your life. Permanently following a strict diet can be difficult, especially if you do not have symptoms. But intestinal damage occurs when you eat foods with gluten, regardless of whether you notice symptoms. For more information, see:
The following strategies may help you stay with your gluten-free diet:
Following a special diet may be especially hard for children and teens, who often don't want to feel different from their friends. Also, teens seem to have fewer symptoms than younger children after eating gluten. But gluten, if eaten, will continue to damage the intestine. This is why it is important for your teen to continue to follow a gluten-free diet. The following strategies may help your child or teen to stick to a gluten-free diet:
Some people with celiac disease and their family members may benefit from counseling. Think about talking to your doctor about counseling if you need some extra help managing the emotional challenges that can happen with celiac disease. Counseling can also help you learn ways to talk with your children better and help them follow a gluten-free diet.
Medicines usually are not needed to treat celiac disease. If you or your child has been diagnosed with this condition, your doctor may recommend taking a vitamin supplement that has iron and calcium. After you or your child is on a gluten-free diet, symptoms should get better within 2 or 3 weeks, nutrients should be absorbed more normally, and the small intestine should gradually heal.
Medicine is only needed if you or your child becomes seriously ill with celiac disease or if complications develop. Medicines will be given only long enough to correct these problems. Doctors may prescribe steroid medications to ease swelling in the intestine and to help it absorb nutrients better. But not all experts agree about the use of these medicines to treat celiac disease. Some complications, such as delayed growth, cannot be treated with medicine.
There is no surgical treatment for celiac disease.
You may want to consider seeing a counselor to help you deal with having celiac disease. Professional counseling involves speaking with a qualified counselor, psychologist, or psychiatrist who can help you cope with or change certain thoughts, feelings, or behaviors.
|Celiac Disease Foundation (CDF)|
|13251 Ventura Boulevard|
|Studio City, CA 91604|
CDF provides support, information, and assistance to people affected by celiac disease and dermatitis herpetiformis. The Web site has information about diet and lifestyle changes, including a quick-start diet guide and lists of gluten-free resources. There is also a Kid's Korner with information especially for children and teens who have celiac disease and for their parents.
|Celiac Sprue Association|
|P.O. Box 31700|
|Omaha, NE 68131-0700|
|Phone:||1-877-CSA-4CSA (1-877-272-4272) toll-free
This nonprofit, member-based organization has information for people who have celiac disease and for their families, such as ways they can incorporate a gluten-free diet into their daily lives.
|P.O. Box 6|
|Flourtown, PA 19031|
The GastroKids website helps parents, children, and teens learn more about reflux and GERD, celiac disease, inflammatory bowel disease, and other digestive disorders in children. This website is part of the NASPGHAN Foundation (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition).
|Gluten Intolerance Group of North America (GIG)|
|31214 124th Avenue SE|
|Auburn, WA 98092|
This organization provides support, education, awareness, and advocacy to people affected by gluten intolerances.
|National Digestive Diseases Information Clearinghouse|
|2 Information Way|
|Bethesda, MD 20892-3570|
This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
- Catassi C, et al. (2005). Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology, 129(Suppl 1): S79–S86.
Other Works Consulted
- Agency for Healthcare Research and Quality (2004). Celiac Disease (AHRQ Evidence Report/Technology Assessment No. 104). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/epcsums/celiacsum.pdf.
- American Diabetes Association (2012). Standards of medical care in diabetes—2012. Diabetes Care, 35(Suppl 1): S11–S63.
- Case S (2005). The gluten-free diet: How to provide effective education and resources. Gastroenterology, 128(4, Suppl 1): S128–S134.
- Dewar DH, Ciclitira PJ (2005). Clinical features and diagnosis of celiac disease. Gastroenterology, 128(4, Suppl 1): S19–S24.
- Farrell RJ, Kelly CP (2006). Celiac sprue and refractory sprue. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2277–2306. Philadelphia: Saunders Elsevier.
- Gluten-free drugs for celiac disease patients (2008). Medical Letter on Drugs and Therapeutics, 50(1281): 19–20.
- Green PHR, Cellier C (2007). Celiac disease. New England Journal of Medicine, 357(17): 1731–1743.
- Haboubi NY, et al. (2006). Coeliac disease and oats: A systematic review. Postgraduate Medical Journal, 82(972): 672–678.
- Hill ID, et al. (2005). Guideline for the diagnosis and treatment of celiac disease in children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 40(1): 1–19.
|Primary Medical Reviewer||Susan C. Kim, MD - Pediatrics|
|Specialist Medical Reviewer||Jerry S. Trier, MD - Gastroenterology|
|Last Revised||September 13, 2011|
Last Revised: September 13, 2011
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