Celiac Disease: Causes, Symptoms & Treatment

A guide to celiac disease - an autoimmune disorder triggered by gluten that damages the small intestine

10 min readLast updated: 2026-02-17

Quick Facts

Prevalence
~1% of the global population
Underdiagnosed
Up to 80% of cases undiagnosed
Treatment
Strict lifelong gluten-free diet

What Is Celiac Disease?

Celiac disease is a serious autoimmune disorder in which eating gluten -- a protein found in wheat, barley, and rye -- triggers an immune response that damages the lining of the small intestine. This damage impairs the absorption of nutrients and can lead to a wide range of symptoms and long-term health complications. Celiac disease affects approximately 1% of the global population, though up to 80% of cases remain undiagnosed.

What Is Gluten?
Gluten is a group of proteins found in wheat (including spelt, kamut, farro, and durum), barley, and rye. It gives bread its chewy texture and is used as a thickener in many processed foods. Gluten is found not only in obvious sources like bread and pasta, but also in sauces, soups, processed meats, beer, and many unexpected products. Oats are naturally gluten-free but are frequently cross-contaminated.

Symptoms

Celiac disease presents very differently in different people:

Classic GI symptoms:

  • Chronic diarrhea or constipation
  • Bloating and gas
  • Abdominal pain
  • Nausea and vomiting
  • Foul-smelling, fatty, pale stools (steatorrhea)

Non-GI symptoms (common in adults):

  • Iron deficiency anemia unresponsive to supplementation
  • Fatigue
  • Bone loss (osteopenia, osteoporosis)
  • Dermatitis herpetiformis (intensely itchy skin rash with blisters)
  • Mouth ulcers
  • Joint pain
  • Numbness and tingling in hands and feet (peripheral neuropathy)
  • Headaches
  • Infertility and recurrent miscarriage
  • Elevated liver enzymes
  • Depression and anxiety

Diagnosis

Important: Patients must be eating gluten at the time of testing for accurate results.

  • Blood tests: Tissue transglutaminase IgA antibody (tTG-IgA) -- the primary screening test (sensitivity >95%). Also total IgA to rule out IgA deficiency
  • Upper endoscopy with biopsy: Gold standard for confirming the diagnosis; shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes
  • Genetic testing: HLA-DQ2 or HLA-DQ8 -- virtually all celiac patients carry one of these; negative results essentially rule out celiac disease
Clinical Note
Do not start a gluten-free diet before completing diagnostic testing. Removing gluten can normalize antibody levels and allow intestinal healing, making diagnosis impossible. Patients should consume gluten equivalent to at least 1-2 slices of bread daily for at least 2-4 weeks before testing.

Treatment

Strict gluten-free diet -- the only treatment:

  • Complete elimination of wheat, barley, rye, and their derivatives
  • Careful reading of food labels
  • Awareness of cross-contamination (shared cooking surfaces, utensils, toasters)
  • Safe grains: rice, corn, quinoa, buckwheat, millet, sorghum, certified gluten-free oats
  • Consultation with a dietitian experienced in celiac disease is strongly recommended
  • Most patients experience symptom improvement within days to weeks of starting the diet
  • Intestinal healing takes 6-12 months in children and up to 2-3 years in adults

Monitoring:

  • Follow-up tTG-IgA levels to verify adherence and response (should normalize)
  • Nutritional deficiency screening (iron, B12, folate, vitamin D, calcium, zinc)
  • Bone density testing
  • Annual follow-up with gastroenterologist
Warning
Even small amounts of gluten can cause intestinal damage in celiac disease, even without symptoms. Strict adherence to a gluten-free diet is essential to prevent long-term complications including osteoporosis, infertility, neurological problems, and a slightly increased risk of certain cancers (intestinal lymphoma). "Mostly gluten-free" is not sufficient.

When to See a Doctor

See a doctor if you have persistent digestive symptoms, unexplained anemia, unexplained weight loss, or if celiac disease runs in your family (first-degree relatives have a 10% risk). Get tested before starting a gluten-free diet.

Medically reviewed by

Medical Review Team, Gastroenterology

Last updated: 2026-02-17Sources: 2

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