Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.
Briana Evers
Development Manager, Celiac Disease Foundation
Celiac disease is estimated to affect 1 in 100 people worldwide, with 2.5 million Americans undiagnosed and at risk for long-term health complications. Celiac disease is commonly associated with gastrointestinal symptoms, but these symptoms make up only a portion of the more than 200 possible symptoms associated with the disease, which can actually affect every organ in the body. Celiac disease symptoms can differ between children and adults, and testing and diagnostic methods for celiac disease are also dependent on the age of the patient.
Symptoms in children
Celiac disease may develop any time after wheat or other gluten-containing foods are introduced into the diet, typically after 6-9 months of age. Celiac disease symptoms in infants, toddlers, and children include, but are not limited to:
- Abdominal bloating and pain
- Anxiety and depression
- Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities
- Chronic diarrhea
- Constipation
- Damage to tooth enamel
- Delayed puberty
- Failure to thrive
- Fatigue
- Gas
- Headaches
- Iron-deficiency anemia
- Irritability
- Nausea and vomiting
- Pale, foul-smelling stools
- Seizures and lack of muscle coordination
- Short stature
- Weight loss
Celiac disease can manifest without symptoms, but if a child has an associated disease, he/she should be tested for celiac disease as well. Associated diseases include:
- Down syndrome
- IgA deficiency
- Juvenile chronic arthritis
- Thyroid disease
- Turner syndrome
- Type 1 diabetes
- Williams syndrome
Symptoms in adults
Common symptoms in adults include, but are not limited to:
- Abdominal pain
- Bloating or gas
- Cognitive impairment
- Constipation
- Diarrhea
- Depression and anxiety
- Fatigue
- Headaches or migraines
- Iron-deficiency anemia
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Joint pain
- Missed menstrual periods
- Mouth ulcers and canker sores
- Nausea and vomiting
- Osteoporosis and osteomalacia
- Peripheral neuropathy
- Reduced functioning of the spleen (hyposplenism)
- Weight loss
Testing and diagnosis by age group
Children must consume gluten for at least one year before an autoimmune response shows up in testing. Children at risk for celiac disease can be screened at age two or three unless symptoms are recognized beforehand, but an antibody test given before the age of three may not be accurate. Genetic testing can be done to rule out celiac disease if neither gene associated with celiac disease (HLA DQ2 and HLA DQ8) is present, but it cannot diagnose celiac disease.
For young children with symptoms of malabsorption and a very high tTG-IgA (tissue transglutaminase) concentration (>10 times upper limit of normal), some physicians may recommend avoiding endoscopic biopsy and immediately starting a gluten-free diet. Others may recommend genetic testing for additional confirmation. Resolution of symptoms while on a gluten-free diet may be used to confirm the diagnosis.
If your child is experiencing celiac disease symptoms, find a Celiac Disease Center or pediatric gastroenterologist near you to have him/her evaluated for celiac disease.
For older children and adults, a doctor can test for celiac disease using the Tissue Transglutaminase IgA antibody test. This test will be positive in 98% of people with celiac disease on a gluten-containing diet. To confirm diagnosis, an intestinal biopsy via endoscopy is performed and will show the extent of the damage to the small intestine. Children and adults should also be tested if a close family member has been diagnosed with celiac disease.
If you are experiencing celiac disease symptoms, it is important to visit a gastroenterologist for testing before beginning a gluten-free diet. All testing for celiac disease must be done while the patient is on a gluten-containing diet for accurate test results. If you are currently on a gluten-free diet, your physician may recommend a gluten challenge to allow antibodies to build in your bloodstream prior to testing. The Celiac Disease Center at the University of Chicago recommends eating gluten every day, in an amount equivalent to at least one slice of bread, for at least 2-3 weeks prior to undergoing biopsy. Please consult with your gastroenterologist regarding your gluten challenge.
If you have undiagnosed symptoms that can be explained by celiac disease, take the Celiac Disease Foundation’s Symptoms Assessment Tool survey to find out if you have an increased risk for celiac disease. Once you complete the survey, you’ll receive an email with a printout to give to your doctor detailing the symptoms you reported and the correct tests the physician should run for a celiac disease diagnosis.