February 10, 2012

Dear Mayo Clinic:

What are the early symptoms of celiac disease? What causes this disease?

Answer:

Celiac disease is a digestive disorder triggered by gluten, a protein found in foods that contain wheat, barley or rye. When people who have celiac disease eat gluten, the result is a reaction in their small intestine that can lead to symptoms such as diarrhea, abdominal pain, bloating and weight loss. Early diagnosis of celiac disease is important because if left untreated the disorder can result in serious complications.

Celiac disease is an immune disorder. The immune system mistakenly targets 'friends,' like foods or even healthy organs and tissue. When a person has celiac disease, the body's immune system overreacts in response to gluten, damaging the small intestine and reducing its ability to absorb nutrients.

The underlying cause of celiac disease appears to be based, in part, on a person's genetic makeup. Research has found that celiac disease tends to run in families, and some gene types increase a person's risk for developing the disease. There's more involved than just genetics, though. Most people who have the gene types that put them at risk for celiac disease never develop the disorder, while others begin having symptoms early in life, and still others are not affected until their 60s or older.

Conditions that put a person's immune system on high alert may activate the disease. For example, some research suggests that certain infections, particularly gastroenteritis, could spark the immune system response associated with celiac disease. The disease is more common in children delivered by cesarean section. Pregnancy also may play a role. Some women develop the disease several months after giving birth.

When celiac disease begins, the most common symptoms are diarrhea, abdominal pain or bloating, especially after meals. People with celiac disease may lose weight because their bodies are not able to absorb enough nutrients from food.

Over time, a range of problems may develop as a result of the body's reaction to gluten — from skin rashes and lactose intolerance to infertility, bone weakness and nerve damage. These can often happen even in the absence of digestive symptoms.

If you have symptoms of celiac disease, see your doctor to have them evaluated before changing your diet. Diagnosing the disease typically involves a blood test and a biopsy of tissue from the small intestine to check for damage. In a few cases, genetic testing may also be helpful.

Celiac disease has no cure but can be managed by avoiding all sources of gluten. Once gluten is eliminated from your diet, your small intestine can begin to heal. The earlier the disease is found, the less time healing takes. For example, most children diagnosed with celiac disease heal completely within six months when gluten is removed from their diets.

Full healing can take longer for adults, sometimes up to a year or two. People who have symptoms for quite a while may take longer to heal, and some never completely recover. In addition, certain advanced complications of the disease may not be reversible, including infertility and severe bone loss. For most people with celiac disease, however, symptoms ease significantly once they start to avoid gluten.

Completely eliminating gluten from your diet can be challenging because gluten is found in many common foods, including bread, pasta, cookies and pizza crusts, just to name a few. But those who have celiac disease need to completely eliminate gluten from their diet, because even small amounts can continue to damage the small intestine. Fortunately, as awareness about celiac disease has increased, more gluten-free items are available in many grocery stores. If you have been diagnosed with celiac disease, consult with a dietitian who can help you plan a healthy gluten-free diet.

— Joseph Murray, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

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