Celiac Disease Symptoms: When Gluten May Be the Problem and How It Is Tested

What it involves

MedlinePlus describes celiac disease as an autoimmune condition that damages the lining of the small intestine through a reaction to gluten, a substance found in wheat, rye, barley and possibly oats. The damaged intestine cannot fully absorb nutrients from food.

Who this is for

• Adults with long-lasting bloating, gas, abdominal pain or changes in bowel habits
• Patients with low iron or anemia that has no clear cause
• People with a family member who has celiac disease
• Patients with type 1 diabetes, thyroid disease or an autoimmune condition and new digestive symptoms

What to expect

• Questions about your symptoms, your diet, weight changes and any family history of celiac disease
• An exam and blood work, which can include a blood count, a metabolic panel and iron or vitamin levels
• Celiac antibody blood tests when the picture fits, while you are still eating gluten
• A referral to a gastroenterologist for an upper endoscopy and biopsy if the antibody tests are positive

Why it is easy to miss

MedlinePlus says the symptoms differ from person to person, which makes celiac disease hard to diagnose. One person may have constipation, a second diarrhea and a third no bowel problem at all. The disease can develop at any point in life, from infancy to late adulthood, and people may be overweight or of normal weight. Because the same complaints fit irritable bowel syndrome, a visit that only treats the symptom can leave the cause untouched, and the irritable bowel syndrome guide lists the other possibilities.

Digestive symptoms

The encyclopedia lists abdominal pain, bloating, gas or indigestion, constipation, decreased appetite, diarrhea that is constant or off and on, nausea and vomiting, stools that are foul smelling, oily or stick to the toilet, and unexplained weight loss. Lactose intolerance is common when celiac disease is diagnosed and often goes away after treatment, and the lactose intolerance guide and bloating and gas guide describe the overlapping symptoms.

Symptoms outside the gut

Because the intestine cannot absorb key nutrients, MedlinePlus says problems can develop over time that include easy bruising, depression or anxiety, fatigue, hair loss, an itchy skin rash called dermatitis herpetiformis, missed periods, mouth ulcers, muscle cramps and joint pain, nosebleeds, and tingling or numbness in the hands or feet. Low iron is a common clue, and the low iron and anemia guide explains how it is worked up. Numbness has many causes, covered in the numbness and tingling guide.

Who is more likely to have it

MedlinePlus says people who have a family member with celiac disease are at greater risk, and that it is most common in people with European heritage. People with celiac disease are also more likely to have other autoimmune disorders such as rheumatoid arthritis, lupus and Sjogren syndrome, thyroid disease, type 1 diabetes, Addison disease and Down syndrome. Anyone with one of those who develops new digestive symptoms is a reasonable person to test, and the thyroid care page describes how thyroid disease is followed.

How it is tested

MedlinePlus says blood tests can detect antibodies, including tissue transglutaminase antibodies and anti-endomysial antibodies, and that a provider orders them if celiac disease is suspected. Other tests it lists include a complete blood count, a metabolic panel and iron, ferritin, folate, vitamin B12 and vitamin D levels. If the antibody tests are positive, an upper endoscopy with a small-bowel biopsy is often performed. The complete blood count guide explains the first of those blood tests.

Do not stop eating gluten before testing

MedlinePlus is direct about this: you should not begin the gluten-free diet before you are diagnosed, because starting the diet will affect testing for the disease. Once celiac disease is confirmed, the treatment is a lifelong gluten-free diet, which lets symptoms go away and the intestinal lining heal, and a provider may prescribe vitamin and mineral supplements. Reading food and medicine labels carefully is part of the job. Follow-up blood tests show how well treatment is working.

Sources

• MedlinePlus: Celiac disease - sprue (medical encyclopedia)
• MedlinePlus: Celiac Disease (health topic)