Celiac Disease Clinic
What is celiac disease?
Celiac disease is a chronic digestive disorder that occurs in genetically susceptible individuals. This multisystem disorder is caused by the body's immune system reacting to proteins in wheat, rye and barley. The immune reaction damages the lining of the small intestine, causing reduced nutrient absorption. When the intestinal villi in the small intestine are damaged, the body cannot absorb critical vitamins, minerals and calories. This condition continues as long as these proteins are in the diet.
Dr. Shiela Crowe, director of the adult celiac disease clinic at UC San Diego Health System discusses the incidence of celiac disease and its treatment.
Are you at risk for celiac disease?
Celiac disease can develop at any time in a person’s life. Currently, the average age of diagnosis is between ages 50 to 60. Approximately one in 100 people in the United States are estimated to have the disease, yet only a small percentage of individuals with celiac disease are diagnosed. Current estimates are that there are more than 2 million people nationwide with celiac disease who have not been diagnosed.
The main risk factor is having a family member with celiac disease. The disease can affect anyone, but it tends to be more common in those with existing autoimmune diseases (e.g., autoimmune liver disease, type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease).
Celiac disease symptoms
Symptoms of celiac disease can relate to the digestive system or in other parts of the body. From person to person, symptoms can vary a great deal, which can make a definitive diagnosis difficult.
One person may have depression, irritability or fatigue, while another may have diarrhea, constipation, gas, bloating or abdominal pain. These symptoms can also sometimes first appear after an episode of gastroenteritis, severe emotional distress, abdominal surgery, pregnancy or childbirth.
Look for any of the following symptoms:
- Bloating, gas or abdominal pain
- Constipation or diarrhea
- Significant unexplained weight loss
- Chronic fatigue and weakness
- Unexplained anemia
- Premature onset of osteoporosis
- Itchy skin rash with small blisters
- Irritability or behavior change
- Mouth ulcers
- Tingling or numbness in hands or feet
- Migraine headaches
Diagnosing celiac disease
While celiac disease primarily affects the gastrointestinal tract, it is now recognized that the condition can affect other organ systems without showing noticeable gastrointestinal symptoms. This makes diagnosing celiac disease challenging.
Several blood tests are available to test for celiac disease. The blood tests measure for certain antibodies, including IgA tissue transglutaminase antibody (also known as tTG antibody), IgA anti-endomysial antibody, and IgA and IgG antibodies to deamidated gliadin known as DGP antibodies. The main test used for screening for celiac disease is the tTG-IgA test.
If the tests results are positive, or if the clinical picture suggests celiac disease, an upper endoscopy is performed to get a biopsy from the first part of the small intestine (duodenum). The biopsy is required to establish a definite diagnosis of celiac disease. Sometimes the symptoms are so pronounced that an endoscopy and biopsy is performed even if the celiac disease antibody test results are negative. Up to 10 percent of patients with celiac disease who eat gluten have a normal level of tTG IgA.
Prior to celiac disease diagnosis
It is recommended not to start a gluten-free diet before you are diagnosed. Small intestine damage caused by gluten in people with celiac disease is reversible, and eliminating gluten from the diet before the biopsy is performed can interfere with obtaining accurate test results. Antibody levels decline once you start a gluten-free diet, which also contributes to blood test inaccuracy.
The biopsy can take well over a year or two before it returns to normal so it is recommended that a biopsy is obtained soon after a patient on a gluten-free diet sees the physician.
Celiac disease is not the same as a wheat allergy or gluten sensitivity without intestinal damage (non-celiac gluten sensitivity). The hereditary nature of the disease and the risk of nutritional deficiencies, other autoimmune diseases and GI cancers make it important for a person to be properly diagnosed. There are several digestive conditions that can cause symptoms from eating wheat, grains and starches, which are treated differently than celiac disease.
Read more about the differences between these conditions and diseases at the American Celiac Disease Alliance.
Celiac disease treatment
Currently, treatment for celiac disease involves following a lifelong gluten-free diet, similar to those with wheat allergies. This means strictly avoiding wheat, barley and rye, as well as certain foods, drinks and medications.
Maintaining a gluten-free diet can be challenging and life altering. Our specialists include dieticians who provide tailored nutritional counseling to help patients with celiac disease and other food sensitivities find foods that are satisfying and healthy. We work closely to provide you with recipes, tips for dining out and useful information on staying gluten-free.
UC San Diego Health System Expertise
In addition to advanced diagnostic techniques and nutritional counseling, UC San Diego Health System provides opportunities for you to participate in clinical trials examining new treatment options for celiac disease. Read more about our research and clinical trials.
To meet the clinical needs of people with celiac disease, we run a pediatric celiac disease clinic, directed by Dr. Kimberly Newton, and an adult celiac disease clinic, directed by Dr. Sheila Crowe.