Celiac disease/gluten-sensitive enteropathy

Overview – Celiac disease is an immune reaction in the small intestine to gluten. Gluten is found in wheat, barley, and rye.

Over time this immune response to gluten damages the small intestine causing malabsorption (nutrients are not absorbed well).

The exact cause of the celiac disease is not known. There is a combination of genes, eating foods with gluten, and other factors involved in the development of the disease. Celiac disease is more common in people who have type 1 diabetes, dermatitis herpetiformis, autoimmune thyroid disease, down’s syndrome or turner’s syndrome, Addison’s disease, a family member with celiac disease.


  • Diarrhea with bulky, foul-smelling, floating stools
  • Bloating and gas
  • Abdominal pain
  • Constipation
  • Nausea and vomiting
  • Weight loss
  • Growth failure in children
  • Itchy blistery skin rash
  • Mouth ulcers
  • Joint pain
  • Headaches
  • Seizures
  • Depression
  • Peripheral neuropathy (Weakness, numbness, pain from nerve damage)


  • Malabsorption can lead to malnutrition and cause slow growth and short stature in children. anemia, weight loss.
  • Osteomalacia or rickets in children due to malabsorption of calcium and vitamin D and softening of the bone.
  • Osteopenia or osteoporosis in adults due to malabsorption of calcium and vitamin D and loss of bone density.
  • There is a greater risk of intestinal lymphoma and small bowel cancer in people who do not maintain a gluten-free diet.
  • Seizures, depression and peripheral neuropathy are associated disorders.


  • Blood tests that help diagnose celiac disease in people with symptoms and signs are serologic testing and genetic testing. In serologic testing, the elevated levels of certain antibody proteins indicate an immune reaction to gluten. These tests are done before trying a gluten-free diet.
  • If the results of these tests indicate celiac disease than endoscopy with biopsy is done to analyze the damage to the small intestine.
  • Your doctor may take a small sample of skin tissue if you have dermatitis herpetiformis.

Lifestyle management

  • Follow a healthy diet and exercise program as recommended by your doctor. The cornerstone of the treatment of celiac disease is the elimination of gluten in the diet. Even trace amounts of gluten in your diet can be damaging to the intestines. Your doctor may refer you to a registered dietitian who is knowledgeable about celiac disease.
  • The principal sources of dietary gluten are wheat, rye, and barley. Some additives such as stabilizers or emulsifiers may contain gluten. Read labels on prepared foods and condiments carefully.
  • Other non-food products containing traces of gluten may be medications, vitamin and mineral supplements, lipstick products, mouthwash, toothpaste, envelope and stamp glue, playdough.
  • Lactose-containing products should initially be avoided in patients whose symptoms appear to be worsened by them. Dairy products may not be well tolerated initially since many patients with celiac disease can have secondary lactose intolerance.
  • Soybean or tapioca flours, rice, corn, buckwheat, fruits, lentils, eggs, nuts, vegetables, potatoes are safe.
  • Keep all your appointments with your doctor. Your doctor will monitor your response to the gluten-free diet periodically.
  • People with celiac disease should be up to date with all vaccinations.
  • Screening of first-degree relatives (particularly siblings) is done if you are diagnosed with celiac disease.

Medical management

  • Anemia and nutritional deficiency are generally treated with vitamins and supplements.
  • Steroids, azathioprine, budesonide are generally given to reduce the inflammation which causes severe damage to the intestine.
  • Skin rash may be treated with dapsone.

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