Celiac disease is an autoimmune condition that causes the body's immune system to respond to the protein gluten by damaging the lining of the small intestine. Gluten is found in wheat, rye, barley and a few other grains.
The normal intestinal lining is covered with tiny, finger-like structures called villi that help the intestine absorb food. In celiac disease, the villi are flattened instead of being long and narrow, which decreases the intestine's ability to absorb nutrients. As a result, stomach pain and diarrhea may develop along with anemia, malnutrition or vitamin deficiencies. Symptoms can extend beyond the intestines and include short stature, arthritis or joint pain, dental enamel defects and a certain type of skin rash called dermatitis herpetiformis.
Celiac disease is also called celiac sprue, sprue, nontropical sprue and gluten-sensitive enteropathy.
The exact cause of celiac disease is unknown. It is estimated that celiac disease affects 1 in 133 Americans. Only a small fraction of people living with celiac disease in the United States have been diagnosed at this time.
Children with a family member who has celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and people of European ancestry, but people from diverse ethnic backgrounds can develop celiac disease if they have the right genetic risk factors. The disease can develop at any time in life, from infancy to late adulthood.
Most children with celiac disease have one or more symptoms, but not all have digestive problems. Some people with the disease have no symptoms. The symptoms of celiac disease can vary significantly from person to person and include:
- Slowed growth
- Weight loss
- Stomach pain
- Feeling very tired or having a low mood
- A very itchy skin rash with blisters
- Constipation (this is a rare symptom)
Having one or more of these symptoms does not mean a child has celiac disease. Many other disorders also include these and similar symptoms.
Diagnosis of Celiac Disease
If your child has symptoms of celiac disease, a pediatric gastroenterologist can perform different tests to help make a diagnosis. Tests include:
- Blood tests. A blood test can detect higher levels of antibodies common in people with celiac disease. Antibodies are produced by the body in response to substances that the body thinks are a danger. Since the disease runs in families, immediate family members of patients with celiac disease should also undergo blood testing.
- Endoscopy. If blood work results show increased antibodies, your child's pediatric gastroenterologist will likely perform an endoscopy procedure to obtain biopsies of the intestine. These tissue samples can help prove the diagnosis. Your child should eat a regular diet that includes gluten before and during testing to ensure accurate results.
Allergy testing or skin testing against wheat is not helpful in the diagnosis of celiac disease.
Celiac disease is a lifelong condition. The only treatment for celiac disease is to avoid eating foods that contain gluten. Even tiny amounts of gluten can damage the intestine. The small intestine will heal as gluten is eliminated from the diet. A dietitian can teach you and your child how to select gluten-free foods. You will learn to check labels of foods and other items for gluten.
Examples of allowed foods include:
- Indian rice grass
- Job’s tears
- Wild rice
Examples of foods to avoid include:
- Bromated flour
- Durum flour
- Enriched flour
- Graham flour
- Phosphated flour
- Plain flour
- Self-rising flour
- Cracked wheat
- Hydrolyzed wheat protein
- Wheat bran
- Wheat germ
- Wheat starch
- White flour
Examples of processed foods that may contain wheat, barley or rye include:
- Bouillon cubes
- Cold cuts, hot dogs, salami, sausage
- Communion wafer
- French fries
- Imitation fish
- Potato chips
- Seasoned tortilla chips
- Self-basting turkey
- Soy sauce
- Vegetables in a sauce
Many of these foods are available in gluten-free varieties.
Key Points to Remember
Key Points to Remember
- Celiac disease is an autoimmune condition that leads to damage of the small intestine. It is not the same as a wheat allergy, so allergy tests are not helpful in the diagnosis of celiac disease.
- Without treatment, children with celiac disease can become malnourished and develop other health problems.
- Celiac disease is diagnosed by antibody blood tests and a biopsy of the small intestine.
- A gluten-free diet should be followed for life.
- A dietitian can help you choose the right foods for your child.
Support Services & Resources
Support Services & Resources
Visit the websites below to find support groups and services and learn more about celiac disease.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This National Institutes of Health website provides science-based information about the symptoms, diagnosis and treatment of celiac disease.
The American Celiac Society Dietary Support Coalition serves individuals with dietary disorders, including celiac disease.
This website provides advocacy for celiac disease research and resources to help patients live a gluten-free life.
This international nonprofit organization certifies gluten-free foods and food service operations and delivers extensive educational information and resources to those living with celiac disease.
This group promotes understanding and early diagnosis of celiac disease.