Celiac Sprue

  • What Is Celiac Disease?

    Celiac disease, also referred to as celiac sprue and gluten-sensitive enteropathy, is an inherited autoimmune disorder caused by an intolerance to a protein called gliadin that is found in gluten—the component of wheat that makes flour smooth and elastic. A related compound is found in other grains, including barley, rye, bulgur, and matzo meal. Ingestion of gluten produces an immune reaction that damages the lining of the small intestine, resulting in symptoms such as diarrhea, flatulence, bloating, and vitamin deficiency owing to nutrient malabsorption.

    Celiac disease can occur at any age, but usually first appears during infancy or early childhood. Symptoms can be mild or absent, or some patients show no symptoms at all. Cases often go undiagnosed until adulthood. In some instances, people first experience symptoms following an infection, an injury, pregnancy, surgery, or severe psychological stress. Some people have no symptoms but their blood tests may show anemia (low red blood cell count.)

    Celiac disease is often associated with other autoimmune disorders, such as certain thyroid diseases, scleroderma, Sjögren’s syndrome, systemic lupus erythematosus, and type 1 diabetes, and may increase the risk for non-Hodgkin’s lymphoma and cancer of the esophagus. Unexplained infertility may also be caused by celiac disease.

    Non-celiac gluten sensitivity is a relatively new term used to describe individuals who experience symptoms after being exposed to gluten, but do not test positive for the antibodies or intestinal damage as seen in celiac disease. Preliminary scientific study suggests gluten sensitivity is also an autoimmune disorder, but more research is needed.


    Who Gets Celiac Disease?

    Celiac disease occurs throughout the world and affects children and adults.  An estimated 1 in 133 Americans, or about 1 percent of the population, has celiac disease, and that figure may be even higher given that researchers suspect many people are undiagnosed and misdiagnosed.  Individuals with a close relative who has celiac disease should be screened for the condition with a blood test. Screening should also be considered if you have other autoimmune disorders including thyroid disease, particular Hashimoto's thyroiditis, type 1 diabetes, or have unexplained digestive symptoms or weight loss.


    Celiac disease may cause no symptoms or can cause gastrointestinal discomfort, including:

    • Abdominal cramps.
    • Diarrhea (occasional or persistent).
    • Itchy, blistering rash on the elbows, knees, and buttocks called dermatitis herpetiformis, which is a reaction to gluten in the system.
    • Lactose intolerance or difficulty digesting milk or foods made with milk.
    • Loss of appetite.
    • Mood changes, depression.
    • Stomach pain.
    • Stool that is oily or has a gray tinge.
    • Weakness or fatigue.
    • Weight loss.


    In children, signs of celiac disease may include the above symptoms, as well as the following:

    • Distention of the stomach or commonly known as potbelly.
    • Difficulty concentrating and learning.
    • Flat buttocks.
    • Low percentile for height and weight (not growing as expected for age group).


    Several complications can occur in patients with celiac disease, as a result of the body's inability to absorb vitamins, minerals, and other nutrients. Complications from celiac disease include:

    • Birth defects in babies born to mothers with undiagnosed celiac disease.
    • Short stature.
    • Slowed growth in children.


    Causes/Risk Factors

    There is no known cause for celiac disease. Although celiac disease occurs worldwide, it has a higher incidence among people of European descent, especially those of Celtic heritage, such as individuals whose ancestors came from Ireland, Scotland, Wales, or northwestern France, and in people who have other genetic disorders like Down syndrome.


    What If You Do Nothing?

    Celiac disease itself is not directly life-threatening, but over time, if a patient with celiac disease does not adopt a strict, gluten-free diet, damage to the small intestine can lead to more serious complications, including malabsorption, weight loss, retarded growth in children, and gastrointestinal cancers. Although celiac disease is difficult to diagnose, patients can usually eliminate symptoms through complete removal of gluten from the diet.



    • Physical exam and a patient history conducted by a doctor.
    • Blood tests can uncover vitamin and mineral deficiencies; blood serum is analyzed to detect specific antibodies that are highly suggestive of celiac disease. A diet containing gluten must be consumed prior to testing to ensure accurate test results.
    • Stool analysis: stool samples may be analyzed for signs of steatorrhea, or abnormally high levels of fat in the stool due to malabsorption.
    • Intestinal biopsy: The gold standard for diagnosing celiac disease is a biopsy of the lining of the small intestine, which is taken during an endoscopic exam. Usually this procedure is performed if antibodies are detected in the blood test.
    • In some situations, another type of blood test can “rule out” celiac disease by showing that the genes for celiac aren’t present in a certain patient. This can be helpful in family members.
    • Skin biopsy: This test looks for dermatitis herpetiformis, an itchy, blistering rash occurring in up to 25 percent of people with celiac disease.



    There is only one effective treatment for patients with celiac disease, and that is adhering to an entirely gluten-free diet for the rest of their lives. Patients who are extremely sensitive to gluten may also need to use different personal care products, since some items such as shampoos, cosmetics, and toothpaste can contain gluten. Consulting a nutritionist can help patients develop a diet plan that is healthy, balanced and gluten-free.

    • Avoid all sources of gluten from the diet. Most patients are referred to a registered dietitian to learn how to follow this lifelong diet. While there are more gluten-free products available in grocery stores, patients with celiac disease need to be aware of hidden sources of gluten, such as soy sauce, modified food starch, vegetable protein, and even the glue in postage stamps.
    • A gluten-free diet can include rice, soybean, potato and corn flours, a moderate amount of oats, plain meats, fruits, vegetables, and most dairy products.
    • Many people with the disorder also experience lactose intolerance, so dairy foods may have to be avoided.
    • Many patients with celiac disease symptoms also take natural supplements called probiotics. Unfortunately, recent studies have shown that some probiotics that are labeled “gluten-free” are not, and they actually contain gluten. Therefore, any patient with celiac disease who takes natural supplements should discuss this with the doctor.



    Celiac disease is not preventable, but sufferers can reduce the chance of a recurrence of symptoms by following a gluten-free diet.


    When To Call A Doctor

    Call a doctor if you have chronic gastrointestinal discomfort or other symptoms that may signal celiac disease. If you have a family member with celiac disease you might want to consider being tested for the disorder.


    Reviewed by Jenifer K. Lehrer, M.D., Department of Gastroenterology, Aria-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.