Some of the symptoms of celiac disease are gas, stomach bloating and pain that does not go away, diarrhea and constipation. Fatigue and headaches are also common.

People with celiac disease cannot eat gluten. Gluten is a protein found mainly in wheat, barley and rye, but may also be in products you use often, such as soy sauce and salad dressing, as well as some medicines, vitamins and even candies.

When a person with celiac disease eats gluten, the immune system, which is supposed to help protect the body against disease, reacts by hurting the cells lining the small intestine and may also harm other parts of the body such as the skin, bones or brain (nervous system).

The gluten-free diet (GFD) is the only treatment for celiac disease. In many patients with celiac disease, even a small amount of gluten is enough to cause harm, even though they may not feel symptoms. A lifelong GFD will help protect the small intestine and may be able to undo damage that has already happened.

Symptoms

Symptoms of celiac disease can vary widely, and individuals may experience multiple symptoms that come and go. Some people may have digestive issues, while others experience symptoms affecting different parts of the body.

Digestive symptoms are more common in children than in adults.

Digestive symptoms of celiac disease may include:

• Bloating

  
  

• Chronic diarrhea

  
  

• Constipation

  
  

• Gas

  
  

• Lactose intolerance due to intestinal damage

  
  

• Loose, greasy, bulky, and foul-smelling stools

  
  

• Nausea or vomiting

  
  

• Abdominal pain

Some people with celiac disease may experience symptoms that affect other parts of the body, including:

• Dermatitis herpetiformis – an itchy, blistering rash that appears on the elbows, knees, buttocks, back, or scalp

  
  

• Anemia or low red blood cell counts

  
  

• Fatigue – persistent tiredness

  
  

• Joint or bone pain

  
  

• Mental health issues – including depression and anxiety

  
  

• Neurological symptoms – such as headaches, balance issues, seizures, or peripheral neuropathy

  
  

• Reproductive issues in women and men – including infertility, delayed or missed menstrual cycles, and repeated miscarriages

  
  

• Oral symptoms – such as canker sores, dry mouth, or a red, smooth tongue

  
  

• Osteoporosis (weakened bones)

Most individuals with celiac disease experience one or more symptoms before being diagnosed. Symptoms typically improve or disappear after adopting a gluten-free diet but may return with even small amounts of gluten consumption.

In cases where celiac disease is diagnosed later in life, some symptoms, such as short stature or dental defects, may not improve. Even those without noticeable symptoms can still develop complications if the condition remains untreated.

What Causes Celiac Disease?

Celiac disease develops in people with specific genetic factors who consume gluten. Researchers are also studying additional factors that may contribute to the onset of the disease.

Genetic Factors

Celiac disease almost exclusively occurs in individuals with one of two genetic variants, DQ2 or DQ8. People without these gene variants are highly unlikely to develop the condition. Approximately 30% of people have the DQ2 or DQ8 variants, yet only about 3% of them develop celiac disease. Researchers are investigating other genes that may contribute to the likelihood of developing the disease in those with these variants.

Gluten Consumption

Eating gluten triggers an abnormal immune response in people with celiac disease. However, not everyone with the DQ2 or DQ8 gene variants who consumes gluten develops the condition. Studies suggest that children with a genetic predisposition who consume higher amounts of gluten in early childhood may have a greater risk of developing celiac disease.

Other Contributing Factors

Researchers are exploring additional factors that may increase the risk of developing celiac disease, including:

• Frequent infections in early life

  
  

• Certain digestive tract infections

  
  

• Changes in gut microbiome composition, which affects digestion

What are the tests for celiac disease?

After talking about your symptoms with your doctor, tests for celiac disease may be performed. As celiac disease is a lifelong health issue, a correct diagnosis is very important. 

If you think you may have celiac disease, do not get rid of gluten from your diet until your doctor has tested you.

Blood test

A blood test is the most common test, as it is easy and can give a clear answer. Results often take about a week.

A blood test to see if you have celiac disease can only work if you are eating gluten, so be sure to keep gluten in your diet before testing is done. (Only limit gluten from your diet if your doctor tells you to do so.)

Based on the results, your gastroenterologist may wish to do an endoscopy.

Endoscopy

An endoscopy is done to get small pieces of tissue (biopsies) from your small intestine to see if there is damage stopping your body from taking in nutrients, caused by celiac disease.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

References

[3] Laurikka P, Nurminen S, Kivelä L, Kurppa K. Extraintestinal manifestations of celiac disease: early detection for better long-term outcomes. Nutrients. 2018;10(8):1015. doi:10.3390/nu10081015

[4] Celiac disease. National Library of Medicine, MedlinePlus. Reviewed April 2019. Accessed November 5, 2020. https://medlineplus.gov/genetics/condition/celiac-disease

[5] Andrén Aronsson C, Lee HS, Hård Af Segerstad EM, et al. Association of gluten intake during the first 5 years of life with incidence of celiac disease autoimmunity and celiac disease among children at increased risk. JAMA. 2019;322(6):514–523. doi:10.1001/jama.2019.10329

Last Reviewed: October 2020

Celiac disease - AGA GI Patient Center