Celiac disease affects around 1% of people worldwide. In India, it is more common in wheat-consuming northern regions, and many people may remain undiagnosed for years.
Celiac disease is different from wheat allergy and non-celiac gluten sensitivity, which do not damage the small intestine in the same way.
Causes and Risk Factors
Celiac disease develops in people who have a genetic predisposition and are exposed to gluten.
The condition is strongly associated with the HLA-DQ2 and HLA-DQ8 genes.
Risk is higher in people with:
A close family member with celiac disease
Type 1 diabetes
Autoimmune thyroid disease
Down syndrome
Turner syndrome
IgA deficiency
A close relative of someone with celiac disease has an estimated risk of around 1 in 10.
The condition can begin at any age after gluten has been introduced into the diet, from early childhood to older adulthood.
Symptoms
Symptoms vary widely, and some people may have very few or no obvious digestive symptoms.
Digestive Symptoms
Common digestive symptoms include:
Chronic diarrhoea
Bloating
Abdominal pain
Excess gas
Pale or foul-smelling stools
Constipation in some people
Symptoms in Children
Children may develop:
Poor weight gain
Short stature
Delayed puberty
Swollen abdomen
Irritability
Dental enamel defects
Other Symptoms
Adults may develop symptoms outside the digestive system, including:
Iron-deficiency anaemia that does not improve with iron supplements
Fatigue
Unexplained weight loss
Osteoporosis or reduced bone strength
Mouth ulcers
Tingling in the hands and feet
Infertility
Recurrent miscarriage
Raised liver enzymes
Some people develop an intensely itchy, blistering skin condition called dermatitis herpetiformis, which is associated with celiac disease.
Diagnosis
Testing should be performed while the person is still eating gluten.
Starting a gluten-free diet before testing can reduce antibody levels and allow the intestine to begin healing, which may lead to false-negative test results.
Blood Tests
The main screening test is:
Tissue transglutaminase IgA antibody (tTG-IgA)
Total IgA levels are also usually checked.
Endoscopy and Small-Intestine Biopsy
In most adults, diagnosis is confirmed using an upper gastrointestinal endoscopy with small-intestine biopsies.
The biopsy can show flattening and damage to the intestinal villi.
Genetic Testing
Testing for HLA-DQ2 and HLA-DQ8 may be useful in selected cases.
A negative result makes celiac disease very unlikely.
In some children with very high antibody levels, specialists may be able to confirm the diagnosis without performing a biopsy.
Treatment
The treatment for celiac disease is a strict, lifelong gluten-free diet.
Even small amounts of gluten can damage the intestine, including in people who do not notice symptoms after eating it.
Symptoms often begin improving within weeks after starting the diet, while healing of the intestine may take months or several years.
Foods to Avoid
People with celiac disease need to avoid foods containing:
Wheat
Barley
Rye
Common wheat-based foods include:
Atta
Maida
Suji or rava
Dalia
Roti
Bread
Biscuits
Pasta
Some sauces, processed foods and malt-containing products may also contain gluten.
Food labels should be checked carefully.
Cross-contamination is also important. Gluten-free foods may become contaminated through shared:
Flour mills
Cooking utensils
Cutting boards
Frying oil
Storage containers
Naturally Gluten-Free Foods
Many commonly eaten foods are naturally gluten-free, including:
Rice
Jowar
Bajra
Ragi
Maize
Buckwheat or kuttu
Amaranth or rajgira
Pulses and dals
Potatoes
Fruits
Vegetables
Milk
Eggs
Meat
Fish
Oats are tolerated by most people with celiac disease when they are certified gluten-free.
Nutritional Support
Because celiac disease can interfere with nutrient absorption, some people may develop deficiencies.
Supplements may be required for:
Iron
Calcium
Vitamin D
Folate
Vitamin B12
A dietitian experienced in gluten-free diets can help ensure the diet remains nutritionally balanced while avoiding hidden sources of gluten.
Regular follow-up blood tests can help assess whether the diet is working.
Complications
Untreated celiac disease can lead to complications including:
Malnutrition
Osteoporosis
Poor growth in children
Infertility
Neurological problems
Over many years, untreated disease may also slightly increase the risk of small-bowel lymphoma and certain intestinal cancers.
Following a strict gluten-free diet greatly reduces these risks.
When to See a Doctor
See a healthcare professional for:
Persistent diarrhoea
Ongoing bloating
Recurrent abdominal pain
Unexplained weight loss
Anaemia that does not improve with iron treatment
Poor growth in a child
Close relatives of people with celiac disease should also consider discussing screening with a doctor.
Do not begin a gluten-free diet before testing if celiac disease is suspected, as this may make diagnosis more difficult.
The Bottom Line
Celiac disease is a lifelong autoimmune condition in which gluten damages the lining of the small intestine and interferes with nutrient absorption.
Although there is no cure, a strict lifelong gluten-free diet allows the intestine to heal, improves symptoms and greatly reduces the risk of long-term complications.
