What is celiac disease?

Celiac disease is a chronic autoimmune condition triggered by gluten, a protein found in wheat, barley and rye. It can cause digestive symptoms, fatigue and other health problems, but some people have few or no noticeable symptoms.

Understanding what celiac disease is — and how doctors test for it — can help you know when to talk with your doctor.

Celiac disease defined

If you have celiac disease, eating gluten triggers an immune response that damages the lining of your small intestine.

Tiny, fingerlike structures called villi line the small intestine and help your body absorb nutrients from food. When celiac disease damages these villi, your body may have trouble absorbing the nutrients it needs. This is called malabsorption. 

Is celiac an autoimmune disease?

Yes. Celiac disease is an autoimmune disease because gluten triggers your immune system to attack healthy tissue in the small intestine.

Celiac disease is different from nonceliac gluten sensitivity. Both can cause symptoms such as abdominal pain and fatigue, but nonceliac gluten sensitivity doesn’t cause the intestinal damage seen with celiac disease.

How genetics play a role

Celiac disease tends to run in families. If you have a first-degree relative — a parent, sibling or child — with celiac disease, your own risk is about 1 in 10.

But having genetic risk doesn’t mean you’ll necessarily develop the disease. Many people carry genes associated with celiac disease and never develop it.

Celiac disease can develop at any age after a person begins eating gluten.

Celiac disease symptoms

Celiac disease can cause many different symptoms, and some people have no noticeable symptoms at all.

Common symptoms may include:

• Abdominal pain
• Anemia
• Bone or joint pain
• Diarrhea, constipation, bloating or gas
• Fatigue
• Itchy, blistering rash called dermatitis herpetiformis
• Unexplained weight loss 

Children may also have symptoms such as poor growth, delayed development or irritability.

Because symptoms can vary widely and overlap with other conditions, talk with your doctor if you have persistent symptoms or a close relative with celiac disease. 

How is celiac disease diagnosed?

Diagnosis usually begins with a discussion of your symptoms, medical history and family history, followed by testing.  

The first step typically involves a blood test that looks for specific antibodies your immune system produces in response to gluten, including transglutaminase antibodies (tTGA) and endomysial antibodies (AEA). Your provider may also check your total IgA levels, since a deficiency can affect the accuracy of those antibody tests.

If your blood test suggests celiac disease, the next step is often a small intestine biopsy. During this procedure, a provider guides a thin, flexible scope through your mouth to your small intestine and removes a tiny tissue sample to check for damage to the villi.

One important note: These tests only work if you still eat gluten regularly. Cutting gluten out before testing can lead to a false negative, so don’t begin a gluten-free diet on your own before your doctor evaluates you.

Treatment for celiac disease

There’s currently no cure for celiac disease. Treatment is a strict, lifelong gluten-free diet.

Removing gluten can relieve symptoms and allow the small intestine to heal. Many people begin to feel better relatively soon after changing their diet, but healing of the intestine may take longer.

A registered dietitian can help you learn how to avoid gluten while still getting the nutrients you need.

Some people continue to have symptoms despite following a gluten-free diet. If that happens, your doctor may look for hidden sources of gluten, other digestive conditions or another reason for your symptoms.

Living gluten-free

Gluten is found in wheat, barley and rye, so foods such as many breads, pastas, cereals and baked goods need to be avoided unless they’re specifically gluten-free.

Gluten can also appear in less obvious foods and products, so reading labels is important.

Naturally gluten-free foods include:

• Beans
• Corn
• Fish
• Fruits
• Meat and poultry without gluten-containing breading or sauces
• Potatoes
• Rice
• Vegetables 

Cross-contact with gluten can also be a concern. These habits can help:

• Ask questions when eating out. Find out how foods are prepared and whether sauces, dressings, fried foods or shared cooking surfaces could contain gluten.
• Plan for school or work. If needed, talk with teachers, school staff or coworkers about safe food options and ways to prevent cross-contact.
• Prevent cross-contact at home. Some families use separate toasters, cutting boards or other kitchen tools for gluten-free foods.
• Read labels carefully. Check packaged foods for gluten-containing ingredients and look for foods labeled gluten-free when appropriate.

Adjusting to a gluten-free diet takes time, but your doctor and a registered dietitian can help you develop habits that protect your health while keeping your diet balanced.