Celiac disease is a digestive condition resulting in poor absorption of certain nutrients. The cause is gluten, a protein found in foods containing grains.

Celiac disease is a digestive condition triggered by consumption of the protein gluten, which is found in bread, pasta, cookies, pizza crust and other foods containing wheat, barley or rye. Oats may contain gluten as well. When someone with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food.

Eventually, decreased absorption of nutrients (malabsorption) can cause vitamin deficiencies that deprive your brain, nervous system, bones, liver and other organs of vital nourishment, which can lead to other illnesses. This is especially serious in children, who need proper nutrition to develop and grow.

Also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy, celiac disease occurs in people who have a susceptibility to gluten intolerance. Some speculate that celiac disease has been around since humankind switched from a foraging diet of meat and nuts to a cultivated diet that included grains such as wheat. Nonetheless, it has only been in the last 50 years that researchers have gained a better understanding of the condition and how to treat it.

No treatment can eliminate celiac disease. However, you can effectively manage the disease through changing your diet.

Signs and symptoms

There are no typical signs and symptoms for celiac disease. Most people with the disease have general complaints such as intermittent diarrhea, abdominal pain and bloating, or they may have no gastrointestinal symptoms at all. The symptoms of celiac disease can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn's disease, parasite infections, anemia, skin disorders or a nervous condition.

• Abdominal pain

• Bloating

• Crohn's disease

• Depression

• Diarrhea

• Gas and gas pains

• Irritable bowel syndrome (IBS)

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Celiac disease may also present itself in less obvious ways, including irritability or depression, stomach upset, joint pain, muscle cramps, skin rash, mouth sores, dental and bone disorders, and tingling in the legs and feet (neuropathy).

Some indications of malabsorption that may result from celiac disease include:

Dermatitis herpetiformis is an itchy, blistering skin disease that also stems from gluten intolerance. The rash usually occurs on the elbows, knees and buttocks. Dermatitis herpetiformis can cause significant intestinal damage identical to that of celiac disease. However, it may not produce noticeable digestive symptoms. This disease is treated with a gluten-free diet, in addition to medication to control the rash.

• Abdominal cramps

Causes

Normally, your small intestine is lined with tiny, hair-like projections called villi. Resembling the deep pile of a plush carpet on a microscopic scale, villi work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease damages the villi.

Without villi, the inner surface of your small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to digest and absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.

The exact cause of celiac disease is unknown. What is known is that the disease is often inherited. If someone in your immediate family has it, chances are 10 percent to 20 percent that you may have it too. It can occur at any age, although symptoms don't appear until gluten is introduced into the diet.

Many times, for unclear reasons, the disease emerges following some form of trauma: an infection, a physical injury, pregnancy, severe stress or surgery.

Risk factors

Although celiac disease can affect anyone, it tends to be more common in people of European descent and people with disorders caused by a reaction of the immune system (autoimmune disorders), such as:

• diabetes

• Lupus

• Rheumatoid arthritis

When to seek medical advice

If you notice or experience any of the signs or symptoms common to celiac disease, see your doctor. If someone in your family is known to have celiac disease, you may need to be tested. This will help you avoid complications associated with not treating the disease, such as osteoporosis, anemia and certain types of cancer.

Seek medical attention for a child who is pale, irritable, fails to grow and who has a potbelly, flat buttocks and malodorous, bulky stools. Many other conditions can cause these same signs and symptoms, so it's important to talk to your doctor before trying a gluten-free diet.

Screening and diagnosis

Part of the reason for the previous underdiagnosis of celiac disease may be because the disorder resembles several other conditions that can cause malabsorption. Another reason may be that if doctors believe the condition to be rare, they will frequently look to more common disorders to explain the signs and symptoms a person presents. In addition, specific blood tests now allow for diagnosis of people with celiac disease who have very mild signs and symptoms or none at all.

People with celiac disease carry higher-than-normal levels of certain antibodies (antigliadin, anti-endomysium and anti-tissue transglutaminase). Antibodies are specialized proteins that are part of your immune system and work to eliminate foreign substances in your body. In people with celiac disease, their immune system may be recognizing gluten as a foreign substance and producing elevated levels of antibodies to get rid of it.

Doctors use a blood test to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to microscopically examine a small portion of intestinal tissue to check for damage to the villi. The tissue is generally obtained by threading a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and taking a sample of intestinal tissue.

A trial of a gluten-free diet also can confirm a diagnosis, but don't go on such a diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.