Celiac Disease and Other Gluten-related Disorders

Celiac disease is an inflammatory autoimmune disease triggered by gluten, a protein in the cereal grains, wheat, rye, and barley. The treatment is a gluten-free diet. The digestive care specialists at the Celiac Disease Center at NewYork-Presbyterian/Columbia University Medical Center and the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center include national and international leaders in celiac disease diagnosis, treatment, and research. When you come to us for care, you benefit from a team of experts who offer the latest therapies and conduct innovative research to improve the futures of people with this increasingly common disorder.

The gluten-free diet has become extremely popular and has been adopted by some due to sensitivity to gluten in the absence of celiac disease. Many of these individuals may have non-celiac gluten or wheat sensitivity. The specialists at our Centers are very interested in taking care of these patients. It is essential that these individuals be under the supervision of clinicians with expertise in this condition. There are pitfalls in the gluten-free diet and patients adopting a gluten-free diet should initially have celiac disease excluded and be monitored for vitamin deficiencies that can arise from the diet itself.

A Team of Experts in Celiac Disease

Your celiac disease team includes adult gastroenterologists, pediatric gastroenterologists, registered dietitians, pathologists, and others who work together to tailor a plan of care that meets your needs. We also collaborate with other specialists and subspecialists you may need, in fields such as endocrinology, bone metabolism, rheumatology, surgery, hematology, oncology, and neurology. This team approach ensures that you have continuity in care and access to all the doctors you need.

An Accurate Diagnosis

An accurate diagnosis is the first step toward feeling better. Our celiac centers perform the diagnostic testing needed to confirm celiac disease. These include blood tests for antibodies and genes that signal the possible presence of celiac disease.

  • Intestinal biopsy. If you test positive on these blood tests, we may perform an endoscopic biopsy to examine tissue from your small intestine. Celiac disease destroys villi—small, fingerlike structures that line the small intestine and absorb nutrients from food. Without functioning villi (or enough functioning villi), you can become malnourished and susceptible to numerous ailments. The gastroenterologists at the Celiac Center are familiar with the technical details of obtaining the correct number of biopsy specimens from the correct locations. This is a crucial step in establishing the diagnosis as is the pathological interpretation of the biopsy samples.
  • Nutritional assessment. We will also determine whether you have any nutritional deficiencies, such as low levels of iron, folate (a B vitamin), vitamin B12, calcium and parathyroid hormone levels, and vitamin D, as well as copper and zinc levels. Other vitamin levels are assessed under specific circumstances such as when neurological symptoms are present, vitamin E and vitamin B6 levels are measured.

Customized Celiac Disease Treatment

While there is no cure for celiac disease, you can learn to manage your symptoms by eliminating gluten from your diet. By strictly following a gluten-free diet, it is possible to stop and reverse damage to your small intestine. The aim of treatment is for patients to feel well, without symptoms and to normalize the biopsy. Working with a nutritionist who is knowledgeable about celiac disease is extremely important because two issues need to be addressed. The first is identifying gluten containing foods and eliminating them. The second, and more arduous, task is learning what to eat to maintain a healthy and nutritious diet. Our registered dietitians will counsel you on how to:

  • Avoid foods containing wheat, rye, barley in all their forms.
  • Choose foods and flour made from naturally non-gluten containing sources.
  • Purchase nutritious manufactured gluten-free foods.
  • Supplement the diet with vitamins and calcium when appropriate

Non-dietary therapies for Celiac Disease

Increasing knowledge of the pathological mechanisms of the disease together with a great desire for patients to have a drug or medicine to help them with the gluten-free diet has generated great interest in the pharmaceutical industry in celiac disease.

Drugs are currently in Phase I and Phase II studies in their progress through the FDA process of drug approval. The therapeutics that have progressed the most include enzymes to digest gluten, a drug that prevents gluten entering the intestinal wall and a vaccine.

Physicians from our institutions are very involved with this process. Involvement includes advising the pharmaceutical companies on clinical trials and their endpoints as well as enrolling patients in the clinical trials and interpreting and publishing the results.

Specialized Care for Children

Children do not often have trouble following a gluten-free diet as their parent supervises them. However, transition through the different stages of childhood and into young adulthood, such as changing grades or schools can be problematic. We ensure that each child we treat has an established relationship with a registered dietitian—in addition to the guidance of his or her parents—to facilitate these transitions and to support them as adults. As with any chronic medical condition, we take the need for transition of care from adolescence to adulthood very seriously. This is an especially trying period for those with celiac disease as they leave home and parental supervision and attend College or join the workforce.

Comprehensive Management of Celiac Disease

  • Collaborative Care Team. We connect people with celiac disease with specialists who are knowledgeable in the diverse clinical manifestations of this condition. Our patients are seen by dermatologic experts trained in treating dermatitis herpetiformis the itchy blistering rash that is part of celiac disease for some people, and neurologic experts with years of experience recognizing the primary neurological signs of celiac disease—peripheral neuropathy and ataxia (disturbed balance). Other subspecialists include endocrinologists versed in the connections between diabetes and thyroid disease and celiac disease. Hematologists and oncologists are an integral part of the team because anemia is common and lymphoid malignancies are the most common malignant complication.
  • Bone Density Determination. People with celiac disease have an increased risk of osteoporosis and bone fracture.1 We perform bone density tests, which is critical for the management of osteopenia or osteoporosis.
  • Immunization and Infection Reduction Measures. Those with celiac disease have a suboptimal response to hepatitis B vaccination and are at increased risk of developing some infections such as influenza, pneumococcal infections,2 shingles, and tuberculosis. As part of our disease management plan, we ensure each patient is adequately vaccinated to protect against these types of infections.
  • Screening family members. Celiac disease runs in families. Our gastroenterologists conduct genetic, and antibody screening of first degree relatives for patients. During the process, we discuss the benefits and risks of screening and the interpretation of the results with our patients, to ensure greater understanding of the testing outcomes.

A Leader in Celiac Disease Research

All medical and therapeutic advances occur through research. Patients benefit from having their care at Institutions that are leaders in research. In addition to providing comprehensive care for celiac disease, we maintain active research programs to explore topics such as the mechanisms underlying the disorder, the quality of life of people with celiac, and the relationship of celiac disease to other autoimmune diseases. It is only through these very active research programs will environmental, genetic and immunological triggers for celiac disease be identified. Once identified, specific research can be conducted that explores the pathological mechanism of the disease. These discoveries allow for the development of potential drug therapies, cure, and prevention of the disease.

As part of two renowned academic medical centers, our research center is a fertile ground for innovative research and translational studies across a variety of divisions, departments, centers, and institutes.

Our recent discovery of a new gene important in the development of celiac disease, a gene in the increasingly important “dark area,” a long non-coding RNA, There are active research programs with the Pathology Departments, Immunology, and Microbiology, as well as the Mailman School of Public Health. Investigators in our institution have also identified potential biomarkers for non-celiac wheat sensitivity; a breakthrough in this poorly understood condition.4 This exciting finding has laid the ground work for the development of a diagnostic laboratory test for this condition.

Raising Awareness and Advocating for Patients

Our team members raise awareness about celiac disease and educate other medical professionals about the disease. This is reflected in the high frequency that the faculty are invited to give lectures at Grand Round meetings in other Institutions and invited to present conferences and their research at both National and International Medical Conferences. Also, most of the medical reviews in the major journals including the New England Journal of Medicine, the Lancet, BMJ have been authored by members of our team.

We also advocate for people with celiac concerning legislative issues, health, ensuring adequate dietary care in schools, college and universities, and funding for all aspects of celiac disease research, education, and patient care.

Contact

Celiac Disease Center
NewYork-Presbyterian/Columbia

212-342-4529

Center for Advanced Digestive Care
NewYork-Presbyterian/Weill Cornell

877-902-2232