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Celiac Disease (Celiac Sprue) FAQs

Reviewed by Jay W. Marks, MD

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Q:Celiac disease is caused by an allergic reaction to what?

A:Celiac disease is caused by an allergic reaction to gluten. Celiac disease is a disease of the small intestine in which damage to the lining of the small intestine leads to the malabsorption of minerals and nutrients. The destruction of the inner lining of the small intestine in celiac disease is caused by an immunological (allergic) reaction to gluten, a family of proteins found in wheat, barley, rye, and oats.

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Q:With celiac disease, malabsorption means what?

A:With celiac disease, malabsorption means poor absorption of food nutrients. Medically speaking, malabsorption refers to poor intestinal absorption of nutrients, vitamins, and minerals from the intestinal tract into the blood stream. Malabsorption can occur from diseases that injure the bowels, such as Crohn's disease, Whipple's disease, and celiac disease, as well as other diseases and conditions such as HIV, diseases of the pancreas such as cystic fibrosis, surgical removal of large portions of the small bowel, and the presence of intestinal worms.

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Q:There are other diseases associated with celiac disease. True or False?

A:True. About 10% of individuals with celiac disease also have dermatitis herpetiformis. Dermatitis herpetiformis is a disease of the skin that is characterized by an itchy rash on the extremities, buttocks, neck, trunk, and scalp.

Other diseases that are associated with celiac disease are recurrent painful mouth ulcers, insulin-dependent diabetes, juvenile-onset or type 1 diabetes, autoimmune thyroid disease, rheumatoid arthritis, and systemic lupus erythematosus.

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Q:Gluten found in what may also produce an allergic reaction?

A:Gluten found in medicines may also produce an allergic reaction. Gluten is found mainly in foods but may also be found in everyday products such as prescription and nonprescription medicines, vitamins, some kinds of lipstick, and lip balms.

Other products that may contain hidden gluten are malt, which contains barley; hydrolyzed vegetable protein, which contains wheat, and communion wafers.

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Q:People with celiac disease should completely avoid what?

A:People with celiac disease should completely avoid beer, pasta and crackers. Beer contains wheat! Who knew? Unfortunately for fans of the six-pack, most beers are made with barley malt. While there are some gluten-free beers, it's best to check with your doctor or dietitian about whether these are safe for you.

Pasta has got to go as well. No matter what its shape or name, most pasta is made out of wheat. So you'll need to avoid spaghetti, macaroni, shells, and spirals when on a gluten-free diet.

No more crackers, either. If you look at the ingredients label, you'll see that wheat is likely the main ingredient.

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Q:What is true about celiac disease?

A:Celiac disease is genetic. There is evidence that celiac disease is partially genetic (inherited), meaning it runs in families. Once thought of as a rare childhood illness, celiac disease is now known to be a common genetic disorder.

Approximately 10% of the first-degree relatives (parents, siblings or children) of individuals with celiac disease also will have celiac disease. In addition, in approximately 30% of fraternal twins and 70% of identical twins, both twins will have celiac disease. Finally, certain genes have been found to be more common in individuals with celiac disease than in those without celiac disease.

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Q:Severe emotional stress can trigger celiac disease. True or False?

A:True. In some cases, celiac disease seems to be triggered by, or becomes active for the first time, after surgery, pregnancy, childbirth, viral infection, or severe emotional stress. It is unclear how these stresses may be linked to celiac disease. The association may be coincidence.

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Q:Abdominal distention is a key symptom of celiac disease. Abdominal distention means what?

A:Abdominal distention means that the abdomen is swollen. Abdominal distention (abdominal swelling) is a key symptom of celiac disease primarily in infants. Other symptoms include:
In infants: diarrhea, steatorrhea (fatty stools), abdominal cramps, irritability, muscle wasting, and failure to thrive and grow.
In children: diarrhea, fatty stools, flatulence, short stature, and weight loss.
In adults: diarrhea, fatty stools, weight loss, flatulence, iron deficiency anemia, bloating, abnormal bleeding, and bone fractures.

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Q:There is no cure for celiac disease. True or False?

A:True. There is no cure for celiac disease. The treatment of celiac disease is a gluten-free diet. Patients with celiac disease vary in their tolerance to gluten. Some patients can ingest small amounts of gluten without developing symptoms, while others experience massive diarrhea with only minute amounts of gluten.

The standard treatment calls for complete avoidance of gluten for life.

In addition to avoiding foods that obviously contain gluten such as foods containing or derived from wheat, barley, rye, and oats; people with celiac disease must also become aware of gluten that is commonly hidden in many processed foods such as canned soups, salad dressing, ice cream, candy bars, instant coffee, luncheon meats, ketchup, mustard, yogurt, and sausages.

Without treatment through a gluten-free diet, people with celiac disease can develop complications such as osteoporosis, anemia, and possibly cancer.

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Q:Certain conditions cause a person to fail to respond to a gluten-free diet. True or False?

A:True. Failure to respond to a gluten-free diet may occur for several reasons:
- Not following a strict gluten free diet by still eating small amounts of gluten
- Unknowingly ingesting gluten (hidden gluten)
- A co-existing condition such as irritable bowel syndrome, bacterial overgrowth of the small bowel, microscopic colitis, or pancreatic insufficiency
- Refractory disease or complications of celiac disease

Note: Refractory celiac disease is a rare condition in which the symptoms of what appears to be celiac disease do not improve despite many months of a strict gluten-free diet.

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Q:How is celiac disease diagnosed?

A:Celiac disease is diagnosed by intestinal biopsy, blood tests, and the presence of dermatitis herpetiformis. Celiac disease has long been underdiagnosed or misdiagnosed. As doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.

A small intestinal biopsy is another method used to diagnose celiac disease. During an intestinal biopsy, samples of the intestinal lining are obtained. A pathologist then can examine the biopsies under a microscope for the loss of villi and other characteristics of celiac disease.

Dermatitis herpetiformis is often a skin manifestation of celiac disease. It affects 15% to 25% of people with celiac disease, and these people typically have no digestive symptoms of the disease.

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