Celiac disease, also known as gluten-sensitive enteropathy, is an inflammatory autoimmune disease that occurs in genetically susceptible people who eat gluten, the protein in certain grains (eg, wheat, rye, and barley). The disease destroys the small intestine's villi. These are the small, fingerlike structures that line the intestine and absorb the nutrients from food. Without functioning villi (or enough functioning villi) the person can become malnourished and susceptible to numerous ailments.
NewYork-Presbyterian Hospital has a number of experts in celiac disease, including those at the Center for Celiac Disease at NewYork-Presbyterian/Columbia and the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell.
The classic symptom of celiac disease, diarrhea, is seen in only about 50% of adults with this disease. Other gastrointestinal symptoms include constipation, pale, foul-smelling stool, recurring gas, bloating, abdominal pain, and unexpected weight loss or gain. These symptoms may resemble those of other diseases, such as irritable bowel syndrome, making it important to obtain an accurate diagnosis.
Celiac disease also may result in anemia, bone or joint pain, vitamin K deficiency, canker sores inside the mouth, missed menstrual periods, infertility, miscarriage, fatigue or weakness, tooth discoloration or loss of enamel, depression, irritability, headaches, tingling or numbness (neuropathy), seizures, and an itchy skin rash known as dermatitis herpetiformis (only 20% of patients with this rash have gastrointestinal symptoms).
Infants and children may have delayed growth, irritability, and juvenile arthritis, among other symptoms. Some children and adults with celiac disease have only non-gastrointestinal symptoms or no symptoms at all.
Diagnosis is based on a blood test for certain antibodies and nutritional deficiencies in iron, folate (a B-vitamin), vitamin B-12, calcium, vitamin D, copper, and zinc levels. In addition, an endoscopic examination and biopsy of the small intestine is performed to look for changes characteristic of celiac disease.
Since this disease is an inherited condition, it is recommended that first-degree relatives of persons with celiac disease also be tested.
While there is no cure for celiac disease, it is effectively treated by eliminating gluten from the diet. With strict adherence to a gluten-free diet, it is possible to stop and even reverse damage to the small intestine. Avoid foods containing wheat, rye, barley, bulgur, kamut, spelt, and triticale. Instead, eat foods and flour made from rice, potato, corn, buckwheat, teff, quinoa, millet, amaranth, beans, and soy. For patients with dermatitis herpetiformis, a drug called dapsone (diamino-diphenyl sulfone) may help heal rashes. Working with a nutritionist who is knowledgeable about celiac disease is extremely important to maintaining a healthy diet and learning how to check food and medicines for gluten.