Celiac Disease Clinic
Treating Celiac Disease Right
For individuals with celiac disease, a gluten-free diet isn't a lifestyle choice -- it's a necessity.
Led by Sheila Crowe, MD, the celiac disease team at UC San Diego Health System comprises nationally recognized gastroenterologists and dietitian experts who are vastly experienced in treating seriously ill individuals due to celiac disease.
Our dietitians, Kelli Gray-Meisner, RD, and Mary Collard, RD, will work with you to develop a comprehensive, personalized nutritional plan focused on restoring health and managing symptoms of celiac disease on a daily basis.
: Perlman Medical Offices
Meet our gastroenterologists.
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. Sheila Crowe, director of the adult celiac disease clinic at UC San Diego Health System discusses the incidence of celiac disease and its treatment.
Three Facts About Celiac Disease
- Celiac disease can develop at any time in a person’s life.
- Currently, the average age of diagnosis is between ages 40 to 50.
- Approximately one in 100 people in the U.S. are estimated to have celiac disease, yet only a small percentage of individuals are diagnosed.
Are You at Risk?
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
Could You Have Celiac Disease?
It's currently estimated that there are more than 2 million people nationwide with celiac disease who have not been diagnosed.
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 main test used for screening is the tTG-IgA test. Celiac disease blood tests measure for certain antibodies:
- IgA tissue transglutaminase (tTG) antibody
- IgA anti-endomysial antibody
- IgA and IgG antibodies
- Deamidated gliadin peptide (DGP) antibody
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).
An endoscopic biopsy is the only way to confirm 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.
Why You Need A Professional Diagnosis
The hereditary nature of celiac disease and the risk of nutritional deficiencies, other autoimmune diseases and GI cancers make it important to be properly diagnosed.
Up to 10 percent of people 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. The damage to the small intestine that is 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. Similarly, the antibody levels will decline once a gluten-free diet is started, making the blood tests less accurate in diagnosing celiac disease.
Conditions That Can Mimic Celiac Disease
There are other digestive conditions that can cause symptoms from eating wheat and other grains and starches. These conditions are treated differently than celiac disease.
For more information on celiac disease, visit:
Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity (NCGS) is a condition or syndrome which causes digestive symptoms that appear like celiac disease. However, NCGS does not cause intestinal damage or anemia, and the IgA celiac disease antibodies (TTG IgA and DGP IgA) are not elevated.
Patients with NCGS are often extremely sensitive to small amounts of gluten. The causes of NCGS are unknown and there are no diagnostic tests that can confirm the diagnosis of this condition.
A person may have NCGS if they have gluten interolance but do not have the HLA-DQ2 genes.
Wheat Starch Intolerance
Another cause of wheat or gluten sensitivity is wheat starch intolerance.
Wheat is made up of proteins (gluten) and carbohydrates (starch) which are found together in baked goods and other wheat products. A portion of starch (resistant starch) cannot be absorbed or digested by the small intestine and relies on bacteria (in the intestines) to break it down.
While most people can tolerate moderate levels of resistant starch, some individuals (e.g., those with irritable bowel syndrome) are sensitive to it and other fermentable sugars and starches. This sensitivity causes them to develop symptoms of:
- Belly bloating
- Altered bowel habits
- Excessive gas
- Other digestive complaints
Help With FODMAP
A low FODMAP diet can be difficult to follow. UC San Diego gastrointestinal experts can help you with FODMAP and other food intolerances.
People with wheat starch intolerance and IBS may alleviate symptoms with a low FODMAP diet. A low FODMAP diet consists of avoiding or limiting intake of certain carbohydrates that can be found in many natural and processed foods:
Poorly absorbed carbohydrates can lead to an overgrowth of friendly bacteria in the small intestine, known as small intestinal bacterial overgrowth, or SIBO.
SIBO can cause several digestive problems including:
- Food intolerances
- Altered bowel habits
- Abdominal pain or discomfort
- Abdominal bloating
- Excessive flatulence
In more severe cases, you may experience weight loss, anemia and nutritional deficiencies. SIBO can occur in elderly people, after gastrointestinal surgery, and in those who have altered motor function of the digestive tract.
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:
- Barley and rye
- Certain foods, drinks and medications
Maintaining a gluten-free diet can be challenging and life altering.
Our team includes dietitians Kelli Gray-Meisner, RD, and Mary Collard, RD, who provide tailored nutritional counseling to help people with celiac disease and other food sensitivities find foods that are satisfying and healthy. They work closely to provide you with:
- Tips for dining out
- 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.