Celiac disease, also called celiac sprue, nontropical sprue, or gluten-sensitive enteropathy, is an autoimmune disorder that damages the small intestine and interferes with absorption of nutrients from food.  People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.  It can also be found in medicines, vitamins, and lip balm.  When people with celiac disease eat these foods or use these other items, their immune system responds by damaging or destroying the villi lining the small intestine.  Villi are normally responsible for allowing nutrients from food to be absorbed through the walls of the small intestine into the bloodstream.  If villi are not working correctly, one can become malnourished. 

Celiac disease is genetic.  It seems more common in those with family members with other autoimmune disorders such as type 1 diabetes, autoimmune thyroid disease, autoimmune liver disease, rheumatoid arthritis, Addison’s disease, and Sjogren’s syndrome or if the person has an autoimmune disorder themselves.  Sometimes the disease is triggered for the first time after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Symptoms of celiac disease vary from person to person.  Symptoms can occur in the digestive system or other parts of the body.  Digestive symptoms are more common in infants and young children and may include abdominal bloating and pain, chronic diarrhea, vomiting, constipation, pale, foul-smelling, or fatty stool, irritability, and weight loss.  Malabsorption of nutrients can be detrimental to a child’s normal growth and can result in failure to thrive, delayed growth and short stature, delayed puberty, and dental enamel defects.  Adults are less likely to have digestive symptoms.  They have unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in hands and feet, seizures, missed menstrual periods, infertility or recurrent miscarriage, canker sores inside the mouth, and an itchy skin rash called dermatitis herpetiformis.  Some people with the disease may not have any symptoms at all.

Diagnosis of celiac disease is through blood tests detecting autoantibodies consisting of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA).  A person should continue to eat gluten foods during this time to make a clear diagnosis.  If antibodies are at high levels they will have a biopsy of the small intestine. 

The final step is a gluten free diet, and if symptoms go away, a diagnosis is confirmed.  Treatment is a gluten free diet no matter what the symptoms are.  This diet is very cumbersome, and a person should meet with a dietitian for education on label reading and for foods that one should avoid.