Celiac Disease

What is Celiac Disease?

Celiac disease is an autoimmune condition where eating gluten triggers your immune system to attack your small intestine. Gluten is a protein found in wheat, barley, and rye. When people with celiac disease eat gluten, their immune system creates antibodies that damage the intestinal lining. Over time, this damage prevents your body from absorbing nutrients properly.

The small intestine has tiny fingerlike projections called villi that help absorb nutrients from food. In celiac disease, these villi become flattened and damaged. This leads to malabsorption, which means your body cannot take in vitamins, minerals, and other nutrients it needs. Without treatment, celiac disease can cause serious health problems including anemia, osteoporosis, infertility, and neurological issues.

Celiac disease affects about 1 in 100 people worldwide. It can develop at any age, from early childhood through adulthood. The only treatment is following a strict gluten-free diet for life. When gluten is removed completely, the intestinal lining can heal and symptoms typically improve.

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Symptoms

Diarrhea or constipation
Abdominal pain and bloating
Gas and nausea
Fatigue and weakness
Unexplained weight loss
Iron-deficiency anemia
Skin rashes, particularly dermatitis herpetiformis
Mouth ulcers
Joint pain
Headaches or migraines
Numbness or tingling in hands and feet
Brain fog or difficulty concentrating

Some people with celiac disease have no digestive symptoms at all. They may only experience fatigue, anemia, or other non-digestive issues. Children may show delayed growth or failure to thrive. Many people go years without a diagnosis because symptoms can be mild or attributed to other conditions.

Causes and risk factors

Celiac disease is caused by a combination of genetic and environmental factors. You must have certain genes to develop the condition, specifically the HLA-DQ2 or HLA-DQ8 genes. However, having these genes does not guarantee you will get celiac disease. About 30% of the population carries these genes, but only 3% develop the condition. Something in your environment must trigger the immune response, and researchers are still studying what those triggers might be.

Risk factors include having a family member with celiac disease, having type 1 diabetes, having autoimmune thyroid disease, or having Down syndrome or Turner syndrome. Some research suggests that the timing of gluten introduction in infancy, infections, gut bacteria, and other environmental factors may play a role. Celiac disease can develop at any point in life, even if you have been eating gluten without problems for years.

How it's diagnosed

Celiac disease is diagnosed through a combination of blood tests and intestinal biopsy. Blood tests look for specific antibodies that indicate an immune reaction to gluten. The most common test measures tissue transglutaminase antibodies, particularly the IgA type. Other tests include gliadin antibodies and genetic testing for HLA-DQ2 and HLA-DQ8 genes. Your doctor may also check your total IgA level, since some people with celiac disease have IgA deficiency.

Rite Aid offers celiac disease testing through our add-on panel at Quest Diagnostics locations nationwide. If blood tests suggest celiac disease, your doctor will typically recommend an endoscopy with biopsy to confirm the diagnosis. During this procedure, a small tissue sample is taken from your small intestine and examined for damage. It is important to keep eating gluten before testing, as removing it from your diet can cause false negative results.

Treatment options

Follow a strict gluten-free diet for life, avoiding wheat, barley, rye, and contaminated oats
Read food labels carefully and watch for hidden sources of gluten in processed foods
Work with a registered dietitian who specializes in celiac disease
Take vitamin and mineral supplements to correct deficiencies, especially iron, calcium, vitamin D, vitamin B12, and folate
Consider supplements for vitamins A and K if malabsorption has been significant
Get regular follow-up blood tests to monitor antibody levels and nutrient status
Join support groups to learn practical tips for managing a gluten-free lifestyle
Educate family members about cross-contamination and safe food preparation
Carry gluten-free snacks when traveling or eating away from home
Consult with your doctor if symptoms persist despite following a gluten-free diet

Frequently asked questions

Celiac disease is an autoimmune condition where gluten triggers your immune system to attack your small intestine, causing measurable damage. Gluten intolerance, also called non-celiac gluten sensitivity, causes symptoms when eating gluten but does not damage the intestines or show up on blood tests. Celiac disease requires strict lifelong avoidance of gluten, while gluten sensitivity may allow for some flexibility. Only celiac disease can be diagnosed through blood tests and biopsy.

Yes, celiac disease can develop at any age, even if you have eaten gluten without problems your entire life. Many people are diagnosed in their 30s, 40s, or later. Researchers believe that something triggers the immune response in genetically susceptible people, though the exact triggers are not fully understood. If you develop unexplained digestive symptoms, fatigue, or anemia as an adult, celiac disease should be considered.

If you accidentally eat gluten with celiac disease, you may experience symptoms within hours or days, including digestive upset, fatigue, headaches, or skin rashes. Even without symptoms, gluten exposure causes intestinal damage and triggers an immune response. Most people recover within a few days to a week after returning to a gluten-free diet. Frequent accidental exposures can prevent your intestines from healing properly and increase the risk of complications.

Intestinal healing time varies from person to person. Children often heal within 3 to 6 months of starting a gluten-free diet. Adults may take 2 years or longer for complete healing. Symptoms typically improve within weeks of removing gluten, but internal damage takes longer to repair. Your doctor will monitor your progress with follow-up blood tests and may recommend a repeat biopsy to confirm healing.

Most people with celiac disease can safely eat oats, but they must be certified gluten-free. Regular oats are often contaminated with wheat, barley, or rye during growing and processing. Certified gluten-free oats are grown and processed separately to prevent contamination. Some people with celiac disease react to a protein in oats called avenin, so introduce oats slowly and monitor how you feel.

Yes, celiac disease has a strong genetic component. If you have a first-degree relative with celiac disease, your risk increases to about 1 in 10. People with celiac disease carry specific genes called HLA-DQ2 or HLA-DQ8. However, many people with these genes never develop the condition, which means environmental factors also play a role. Family members of people with celiac disease should consider getting tested.

Celiac disease damages the small intestine, which impairs nutrient absorption. Common deficiencies include iron, calcium, vitamin D, vitamin B12, folate, zinc, and magnesium. Some people also have low levels of vitamins A and K. These deficiencies can cause anemia, bone loss, fatigue, and other health problems. Blood tests can identify deficiencies, and supplements can help restore levels while your intestines heal.

Yes, people with celiac disease must avoid gluten for life. Even small amounts of gluten trigger an immune response and cause intestinal damage, whether or not you have symptoms. There is currently no cure or medication that allows people with celiac disease to safely eat gluten. Following a strict gluten-free diet allows your intestines to heal and prevents serious complications like osteoporosis, infertility, and certain cancers.

Yes, some people with undiagnosed celiac disease are overweight or gain weight. While malabsorption often causes weight loss, the body may compensate by absorbing more calories from other nutrients or by increasing appetite. After starting a gluten-free diet, some people gain weight as their intestines heal and nutrient absorption improves. Weight changes vary widely among people with celiac disease.

If you suspect celiac disease, you must eat gluten regularly before testing for accurate results. Removing gluten from your diet causes antibody levels to drop and allows the intestines to begin healing, which can lead to false negative results. If you have already gone gluten-free and want testing, talk to your doctor about doing a gluten challenge. Proper diagnosis is important because celiac disease requires lifelong monitoring and has genetic implications for family members.