“Celiac” comes from the Latin word
for abdomen, but this digestive disease can cause symptoms
throughout the body.
The celiac iceberg
The iceberg represents all people at risk for
celiac disease by virtue of their genes. Those with
latent celiac disease have no symptoms. Those in the
middle have silent or atypical celiac disease —
characterized, for example, by anemia without
gastrointestinal symptoms. The proverbial “tip of
the iceberg” represents those with the classic
symptoms: abdominal bloating, diarrhea, and fatigue.
In very young children, symptoms usually include
diarrhea, vomiting, and stunted growth. Older children and
adolescents may have stomach pain, canker sores, and tooth
enamel defects, and may become depressed or irritable. Some
people diagnosed as adults recall having symptoms during
childhood, but many don’t. Presumably, they’ve had latent
disease most of their lives, and then something — a viral
infection, pregnancy, surgery, or even severe emotional
stress — has provoked the symptoms. “Some of my patients
tell me that they and their family members all got a viral
illness, like the stomach flu. But after the family gets
better, their own symptoms never seem to go away,” says Dr.
Ciaran Kelly, director of the Celiac Disease Center at Beth
Israel Deaconess Medical Center in Boston (BIDMC).
The average age at diagnosis is 46; about 20% of cases
are diagnosed after age 60. In addition to anemia and
osteoporosis, celiac disease is associated with type 1
diabetes, thyroid problems, and dermatitis herpetiformis, a
painful skin condition that involves itchy blisters on the
elbows and knees. These associations are strong. For
example, the rate of celiac disease in people with type 1
diabetes is four to 10 times the average. Infertility,
recurrent miscarriages, and neurological problems such as
ataxia (loss of coordination) have also been linked to this
Diagnosis: Blood tests and biopsies
In a person with celiac disease, gluten produces
higher-than-normal levels of two antibodies: anti-tissue
transglutaminase (tTG-IgA) and antiendomysium (EmA-IgA). The
tTG-IgA screening test is the most sensitive; it identifies
people who are at risk for celiac disease even if they have
no symptoms. If you test positive for these antibodies, Dr.
Kelly and other experts strongly recommend that you undergo
a small-bowel biopsy to confirm the diagnosis. (The biopsy
is a relatively simple procedure performed under local
anesthesia.) Damage to the lining verifies the presence of
celiac disease. Knowing for certain is critical because the
treatment — following a gluten-free diet for a lifetime —
can be challenging and costly.
Doctors strongly discourage people from trying a
gluten-free diet on their own before receiving a firm
diagnosis. That’s because the antibody tests are accurate
only if you are eating gluten-containing foods.
Please continue to Celiac
disease testing page