Celiac Disease (Non-Tropical Sprue)
What Is It?
Celiac disease (also called non-tropical sprue, celiac sprue, gluten intolerance and gluten-sensitive enteropathy) is an intestinal disorder in which the body cannot tolerate gluten. Gluten is a natural protein in many grains, including wheat, barley, rye and oats. People with celiac disease have an immune reaction that is triggered by gluten. The immune reaction causes inflammation at the surface of the small intestine where it damages small structures - villi - on the surface of the intestine. It also damages smaller, hair-sized protrusions called microvilli. Healthy villi and microvilli are needed for normal digestion. When they are damaged, the intestine cannot absorb nutrients properly and you can become malnourished.
A tendency to develop celiac disease is genetic (inherited). Celiac disease is most common among people of northern European descent. Celiac disease is not always recognized because the symptoms can be mild and can be wrongly blamed upon other common intestinal issues. Celiac disease can be diagnosed at any age.
Celiac disease is an autoimmune condition because the body's own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also are more likely to develop other autoimmune diseases, such as thyroid disease and type 1 diabetes. A few conditions frequently coexist with celiac disease, including dermatitis herpetiformis (an itchy, blistering skin rash) and liver inflammation. People who have Down syndrome have a higher risk of developing celiac disease than is typical.
Symptoms and their severity can vary. Some symptoms come from inflammation in the intestines. Other symptoms come from a lack of nutrients, due to the failure of your intestine to digest food properly.
Children generally develop symptoms only after they start eating foods that contain gluten. Common symptoms include:
- Upset stomach
- Failure to grow normally (often called "failure to thrive") or delayed growth
- Weight loss
- Painful abdominal bloating or distention
- Pale, foul-smelling, greasy stools
- Chronic (long-lasting) or recurring diarrhea
In adults, symptoms may include:
- Chronic diarrhea that does not get better with medication
- Foul-smelling, greasy, pale stool
- Recurring abdominal bloating
- Weight loss
- Infertility, lack of menstruation
- Bone or joint pain
- Depression, irritability or mood changes
- Neurological problems, including weakness, poor balance, seizures, headaches, or numbness or tingling in the legs
- Itchy, painful skin rash (dermatitis herpetiformis)
- Tooth discoloration or loss of enamel, sores on lips or tongue
- Other signs of vitamin deficiency, such as scaly skin or hyperkeratosis (from lack of vitamin A), or bleeding gums or bruising easily (from lack of vitamin K)
Blood tests to look for specific antibodies (anti-gliadin, anti-endomysial and anti-tissue transglutaminase) are used to diagnose celiac disease. One or more of these antibodies are found in almost everyone with celiac disease. They rarely are found in people who do not have this disease.
If your doctor suspects celiac disease, he or she may recommend a biopsy of the intestine. A biopsy requires the procedure known as endoscopy (EGD or "esophagogastroduodenoscopy"), which allows your doctor to remove a tiny piece of tissue that can be examined under a microscope. Under a microscope, the biopsy sample can reveal damage to the tiny villi, which will appear flatter than usual. Inflammatory cells can also be seen on a microscope examination of a biopsy.
Celiac disease will cause symptoms as long as you continue to eat gluten. If a person with celiac disease follows a strict gluten-free diet, the intestines can heal and the disease can be controlled. Any exposure to gluten can trigger a recurrence of symptoms.
Because celiac disease is a genetic disorder and because gluten is encountered in almost everyone's diet, there is no practical way to prevent it. If it does occur, you can stop intestinal damage and eliminate your symptoms by following a strict, gluten-free diet. Although it is not proven, some experts suspect that if celiac disease runs in your family you may be able to delay the disease for your own children or reduce the likelihood that they will get the disease by breast-feeding, so that you delay the introduction of other foods to your infant's diet.
Effective treatment sounds simple: Just eliminate gluten from your diet, the intestinal damage will be cured over time, and your symptoms will go away. That's easier said than done, however.
Many products contain gluten. Some products, especially prepared foods, may not list gluten as an ingredient. Today there are many online and print publications to help people with celiac disease avoid gluten in their diet.
Here are some basic tips on avoiding gluten:
Avoid cereals, breads or other grain products that include wheat, rye, barley or oats. This includes white or whole-wheat flour (including cookies, crackers, cakes and most other baked goods), semolina, couscous, bread crumbs, most pastas and malt.
Avoid processed cheese, cheese mixes, low-fat or fat-free cottage cheese or sour cream.
Avoid any dairy products, such as yogurt or ice cream that contain fillers or additives.
Avoid canned soups or soup mixes.
Avoid creamed vegetables.
Avoid products that contain modified food starch, food starch, hydrolyzed vegetable protein, stabilizers, or fat replacers or substitutes.
Avoid prepared or processed meats.
Avoid beer, gin and whiskey.
Avoid flavored coffee, malted milk or herbal tea with malted barley.
Look for products marked "gluten-free." As more attention is being given to this disease, more products are becoming available.
Foods that do not contain gluten include products made with soybean or tapioca flours, rice, corn, buckwheat or potatoes. Other gluten-free foods include nuts; fresh fish, meat or poultry; fresh, frozen or canned vegetables without sauces; wine; and plain, natural cheeses and yogurt.
Current evidence suggests up to 2 ounces of oats each day may be tolerated well by people with celiac disease.
If symptoms are not helped by restricting gluten or if the inflammation in the intestine is severe, your health care professional may prescribe corticosteroids, medication that can reduce inflammation.
When to Call a Professional
See your health care professional if you have chronic diarrhea, chronic fatigue, or weight loss that is unintentional or progressive. The most serious children's symptoms such as failing growth likely will be discovered during routine checkups. You should call your pediatrician if your child develops unexplained weight loss, abdominal pain, prolonged diarrhea, repeated episodes of abdominal bloating, or frequent pain after eating.
Most people who follow a strict gluten-free diet can expect symptoms to improve in a few weeks, and the damage to the intestinal villi typically is reversed in a few months. As long as the diet is followed, people with celiac disease should be able to lead normal lives with no further symptoms. People with celiac disease are at risk of developing another autoimmune disorder. People with celiac disease also have an increased risk of developing small bowel lymphoma, a cancer of the small intestine. Therefore, your physician should consider these possibilities if new problems or symptoms occur.
Left untreated, celiac disease can lead to severe malnutrition and can put you at risk of serious consequences, including osteoporosis (thin bones), anemia, infertility, neuropathy (damaged nerves) and seizures.
National Institute of Diabetes & Digestive & Kidney Disorders
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American Gastroenterological Association
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