Question: What is (are) Celiac Disease ?
Answer: Celiac disease is an immune disorder in which people cannot tolerate gluten because it damages the inner lining of their small intestine and prevents it from absorbing nutrients. The small intestine is the tubeshaped organ between the stomach and large intestine. Gluten is a protein found in wheat, rye, and barley and occasionally in some products such as vitamin and nutrient supplements, lip balms, and certain medications. The immune system is the body's natural defense system and normally protects the body from infection. However, when a person has celiac disease, gluten causes the immune system to react in a way that can cause intestinal inflammationirritation or swellingand long-lasting damage. When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villithe tiny, fingerlike projections on the inner lining of the small intestine. Villi normally absorb nutrients from food and pass the nutrients through the walls of the small intestine and into the bloodstream. Without healthy villi, people can become malnourished, no matter how much food they eat.
Source: NIDDK

Question: What causes Celiac Disease ?
Answer: Researchers do not know the exact cause of celiac disease. Celiac disease sometimes runs in families. In 50 percent of people who have celiac disease, a family member, when screened, also has the disease.1 A person's chances of developing celiac disease increase when his or her genestraits passed from parent to childhave variants, or changes. In celiac disease, certain gene variants and other factors, such as a person's exposure to things in his or her environment, can lead to celiac disease. Read more about genes and genetic conditions at www.ghr.nlm.nih.gov. For most people, eating something with gluten is harmless. For others, an exposure to gluten can cause, or trigger, celiac disease to become active. Sometimes surgery, pregnancy, childbirth, a viral infection, or severe emotional stress can also trigger celiac disease symptoms.
Source: NIDDK

Question: How many people are affected by Celiac Disease ?
Answer: As many as one in 141 Americans has celiac disease, although most remain undiagnosed.2 Celiac disease affects children and adults in all parts of the world and is more common in Caucasians and females. Celiac disease is also more common among people with certain genetic diseases, including Down syndrome and Turner syndromea condition that affects girls' development.
Source: NIDDK

Question: What are the symptoms of Celiac Disease ?
Answer: A person may experience digestive signs and symptoms, or symptoms in other parts of the body. Digestive signs and symptoms are more common in children and can include - abdominal bloating - chronic diarrhea - constipation - gas - pale, foul-smelling, or fatty stool - stomach pain - nausea - vomiting Being unable to absorb nutrients during the years when nutrition is critical to a child's normal growth and development can lead to other health problems, such as - failure to thrive in infants - slowed growth and short stature - weight loss - irritability or change in mood - delayed puberty - dental enamel defects of permanent teeth Adults are less likely to have digestive signs and symptoms and may instead have one or more of the following: - anemia - bone or joint pain - canker sores inside the mouth - depression or anxiety - dermatitis herpetiformis, an itchy, blistering skin rash - fatigue, or feeling tired - infertility or recurrent miscarriage - missed menstrual periods - seizures - tingling numbness in the hands and feet - weak and brittle bones, or osteoporosis - headaches Intestinal inflammation can cause other symptoms, such as - feeling tired for long periods of time - abdominal pain and bloating - ulcers - blockages in the intestine Celiac disease can produce an autoimmune reaction, or a self-directed immune reaction, in which a person's immune system attacks healthy cells in the body. This reaction can spread outside of the gastrointestinal tract to affect other areas of the body, including the - spleen - skin - nervous system - bones - joints Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. Celiac disease can be confused with - irritable bowel syndrome (IBS) - iron-deficiency anemia caused by menstrual blood loss - lactose intolerance - inflammatory bowel disease - diverticulitis - intestinal infections - chronic fatigue syndrome As a result, celiac disease has long been underdiagnosed or misdiagnosed. As health care providers become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing, particularly for adults. Dermatitis Herpetiformis Dermatitis herpetiformis is a chronic, itchy, blistering skin rashusually on the elbows, knees, buttocks, back, or scalpthat affects about 5 to 10 percent of people with celiac disease.3 Men with dermatitis herpetiformis may also have oral or genital lesions. People with dermatitis herpetiformis may have no other signs or symptoms of celiac disease. Skin deposits of antibodiesproteins that react against the body's own cells or tissuescommon in celiac disease cause dermatitis herpetiformis. Ingesting gluten triggers these antibodies. More information is provided in the NIDDK health topic, Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease.
Source: NIDDK

Question: What are the symptoms of Celiac Disease ?
Answer: Signs and symptoms of celiac disease vary from person to person because of numerous factors, including - the length of time a person was breastfed as an infant; some studies have shown that the longer an infant was breastfed, the later the symptoms of celiac disease appear - the age a person started eating gluten - the amount of gluten a person eats - agesymptoms can vary between young children and adults - the degree of damage to the small intestine Some people with celiac disease have no signs or symptoms; however, they can still develop complications of the disease over time. Long-term complications include - malnutrition - liver diseases - intestinal cancer - lymphoma
Source: NIDDK

Question: How to diagnose Celiac Disease ?
Answer: A health care provider diagnoses celiac disease with - a medical and family history - a physical exam - blood tests - an intestinal biopsy - a skin biopsy Medical and Family History Taking a medical and family history may help a health care provider diagnose celiac disease. He or she will ask the patient or caregiver to provide a medical and family history, specifically if anyone in the patient's family has a history of celiac disease. Physical Exam A physical exam may help diagnose celiac disease. During a physical exam, a health care provider usually - examines the patient's body for malnutrition or a rash - uses a stethoscope to listen to sounds within the abdomen - taps on the patient's abdomen checking for bloating and pain Blood Tests A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A blood test can show the presence of antibodies that are common in celiac disease. If blood test results are negative and a health care provider still suspects celiac disease, he or she may order additional blood tests, which can affect test results. Before the blood tests, patients should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a patient stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present. Intestinal Biopsy If blood tests suggest that a patient has celiac disease, a health care provider will perform a biopsy of the patient's small intestine to confirm the diagnosis. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. He or she will give the patient light sedation and a local anesthetic. Some patients may receive general anesthesia. During the biopsy, a health care provider removes tiny pieces of tissue from the patient's small intestine using an endoscopea small, flexible camera with a light. The health care provider carefully feeds the endoscope down the patient's esophagus and into the stomach and small intestine. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. The health care provider then takes the samples using tiny tools that he or she passes through the endoscope. A pathologista doctor who specializes in examining tissues to diagnose diseasesexamines the tissue in a lab. The test can show damage to the villi in the small intestine. Skin Biopsy When a health care provider suspects that a patient has dermatitis herpetiformis, he or she will perform a skin biopsy. A skin biopsy is a procedure that involves removing tiny pieces of skin tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The patient receives a local anesthetic; however, in some cases, the patient will require general anesthesia. A pathologist examines the skin tissue in a lab and checks the tissue for antibodies that are common in celiac disease. If the skin tissue tests positive for the antibodies, a health care provider will perform blood tests to confirm celiac disease. If the skin biopsy and blood tests both suggest celiac disease, the patient may not need an intestinal biopsy for diagnosis. Genetic Tests In some cases, a health care provider will order genetic blood tests to confirm or rule out a diagnosis of celiac disease. Most people with celiac disease have gene pairs that contain at least one of the human leukocyte antigen (HLA) gene variants.4 However, these variants are also common in people without celiac disease, so their presence alone cannot diagnose celiac disease. If a biopsy and other blood tests do not give a clear diagnosis of celiac disease, a health care provider may test a patient for HLA gene variants. If the gene variants are not present, celiac disease is unlikely.
Source: NIDDK

Question: How to diagnose Celiac Disease ?
Answer: In some cases, a health care provider will order genetic blood tests to confirm or rule out a diagnosis of celiac disease. Most people with celiac disease have gene pairs that contain at least one of the human leukocyte antigen (HLA) gene variants.4 However, these variants are also common in people without celiac disease, so their presence alone cannot diagnose celiac disease. If a biopsy and other blood tests do not give a clear diagnosis of celiac disease, a health care provider may test a patient for HLA gene variants. If the gene variants are not present, celiac disease is unlikely.
Source: NIDDK

Question: What are the treatments for Celiac Disease ?
Answer: Most people with celiac disease have a significant improvement in symptoms when they follow a gluten-free diet. Health care providers typically refer people to a dietitian who specializes in treating people with the disease. The dietitian will teach the person to avoid gluten while following a healthy and nutritious diet. The dietitian will give the person instructions for how to - read food and product labels and identify ingredients that contain gluten - make healthy choices about the types of foods to eat - design everyday meal plans For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Symptoms may improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi will absorb nutrients from food into the bloodstream normally. Some people with celiac disease show no improvement after starting a gluten-free diet. The most common reason for poor response to dietary changes is that people are still consuming small amounts of gluten, which can damage the small intestineeven in people without symptoms. Most people start responding to the gluten-free diet once they find and eliminate hidden sources of gluten from their diet. Hidden sources of gluten include additives made with wheat, such as - modified food starch - preservatives - stabilizers Did you know that medications and nonfood products may contain gluten? Medications, supplements, and other products may also contain lecithin, a hidden source of gluten. People with celiac disease should ask a pharmacist about the ingredients in - prescription and over-the-counter medications - vitamins and mineral supplements - herbal and nutritional supplements Other products can be ingested or transferred from a person's hands to his or her mouth. Reading product labels can help people avoid gluten exposure. If a product's label does not list its ingredients, the manufacturer should provide a list upon request. Products that can contain gluten include - lipstick, lip gloss, and lip balm - cosmetics - skin and hair products - toothpaste and mouthwash - glue on stamps and envelopes - children's modeling dough, such as Play-Doh Some people who continue to have symptoms even after changing their diet may have other conditions or disorders that are more common in people with celiac disease. These conditions may include - small intestinal bacterial overgrowth, which happens when too many bacteria grow in the small intestine - pancreatic exocrine insufficiency, in which the pancreas does not produce enough digestive juice - microscopic colitis, an inflammation of the colon that a health care provider can see only with a microscope - IBS - lactose intolerance, a condition in which people have symptoms after consuming milk or milk products - other food intolerances, which may occur because of continued damage to the intestine In some cases, people continue to have difficulty absorbing nutrients despite following a strict gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Their intestines are not absorbing enough nutrients, so they may need to receive nutrients intravenously. Researchers continue to evaluate medications to treat refractory celiac disease. Depending on a person's age at diagnosis, some complications of celiac disease will not improve, such as short stature and dental enamel defects. For people with dermatitis herpetiformis, skin symptoms generally respond to a gluten-free diet and may recur if a person adds gluten back into his or her diet. Medications such as dapsone can control the rash's symptoms. Dapsone does not treat intestinal symptoms or damage, so people with dermatitis herpetiformis should maintain a gluten-free diet, even if they don't have digestive symptoms. Even when a person follows a gluten-free diet, the skin lesions from dermatitis herpetiformis may take months or even years to fully heal and often recur over the years.
Source: NIDDK

Question: What to do for Celiac Disease ?
Answer: - Celiac disease is an immune disorder in which people cannot tolerate gluten because it damages the lining of their small intestine and prevents absorption of nutrients. - When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villithe tiny, fingerlike projections on the inner lining of the small intestine. - A person may experience digestive signs and symptoms, or symptoms in other parts of the body. - Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. - Dermatitis herpetiformis is a chronic, itchy, blistering skin rashusually on the elbows, knees, buttocks, back, or scalpthat affects about 5 to 10 percent of people with celiac disease. - Signs and symptoms of celiac disease vary from person to person because of numerous factors. - Some people with celiac disease have no signs or symptoms; however, they can still develop complications of the disease over time. Long-term complications include malnutrition, liver diseases, intestinal cancer, and lymphoma. - A health care provider diagnoses celiac disease with a medical and family history, a physical exam, blood tests, an intestinal biopsy, and a skin biopsy. - Since celiac disease sometimes runs in families, blood relatives of people with celiac disease should talk with their health care provider about their chances of getting the disease. - Most people with celiac disease have a significant improvement in symptoms when they follow a gluten-free diet. - Health care providers typically refer people to a dietitian who specializes in treating people with the disease. - The dietitian will give the person instructions for how to read food and product labels and identify ingredients that contain gluten. - Medications, supplements, and other products may also contain a hidden source of gluten. - People with celiac disease can eat a wellbalanced diet with a variety of foods.
Source: NIDDK