Diagnosis

Researchers estimate that only 20 percent of people with celiac disease may receive a diagnosis.

Doctors may order two blood tests to help diagnose celiac disease.

  • Serology testing looks for antibodies in your blood. Elevated levels of certain antibody proteins indicate an immune reaction to gluten.
  • Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out celiac disease.

If the results of these tests indicate celiac disease, your doctor may order an endoscopy to view your small intestine and to take a small tissue sample (biopsy) to analyze for damage to the villi.

It's important to be tested for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet may change the results of blood tests so that they appear to be normal.

Treatment

A strict, lifelong gluten-free diet is the only way to manage celiac disease. In addition to wheat, foods that contain gluten include:

  • Barley
  • Bulgur
  • Durum
  • Farina
  • Graham flour
  • Malt
  • Rye
  • Semolina
  • Spelt (a form of wheat)
  • Triticale

Your doctor may refer you to a dietitian, who can help you plan a healthy gluten-free diet.

Once you remove gluten from your diet, inflammation in your small intestine generally begins to lessen — usually within several weeks, though you may start to feel better in just a few days. Complete healing and regrowth of the villi may take several months to several years. Healing in the small intestine tends to occur more quickly in children than adults.

If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn't mean it's not harmful to them. Even trace amounts of gluten in your diet can be damaging, whether or not they cause signs or symptoms.

Hidden gluten can be present in foods, medications and nonfood products, including:

  • Modified food starch, preservatives and food stabilizers
  • Prescription and over-the-counter medications
  • Vitamin and mineral supplements
  • Herbal and nutritional supplements
  • Lipstick products
  • Toothpaste and mouthwash
  • Envelope and stamp glue
  • Play-Doh

Vitamin and mineral supplements

If your nutritional deficiencies are severe, your doctor or dietitian may recommend taking vitamin and mineral supplements. You may need to supplement your levels of:

  • Calcium
  • Folate
  • Iron
  • Vitamin B-12
  • Vitamin D
  • Vitamin K
  • Zinc

Vitamins and supplements are usually taken in pill form. If your digestive tract has trouble absorbing vitamins, your doctor may give them by injection. You need to be sure that the vitamins and supplements are gluten-free.

Follow-up care

If you have celiac disease, you will need medical follow-up to make sure your symptoms have responded to a gluten-free diet. Doctors will also want to be sure you are getting the support you need to maintain the diet for life. They will use blood tests to monitor your response. The results of these tests, which are primarily designed as a way to detect celiac disease, usually become negative once you have been gluten-free for six to 12 months. If test results remain positive, then your doctor may try to find the reason, the most common being unintentional exposure to gluten in your diet.

However, these tests are not perfect, and even if the results become negative, it is possible that you could still be exposed to a significant amount of gluten and continue to have symptoms and damage to your intestines.

If you continue to have symptoms, or your symptoms recur, you may need a follow-up endoscopy with biopsies to ensure that healing has occurred. Adults typically have a greater need for follow-up testing, although children may require it, too. Some doctors recommend a routine re-biopsy if you are diagnosed in adulthood, as healing is often quite slow and uncertain.

It also can be helpful to follow up with an expert dietitian for assistance in adapting to, and maintaining, a healthy, nutritious, gluten-free diet.

Medications to control intestinal inflammation

If your small intestine is severely damaged, your doctor may recommend steroids to control inflammation. Steroids can ease severe signs and symptoms of celiac disease while the intestine heals.

Dermatitis herpetiformis

If you have this itchy, blistering skin rash that sometimes accompanies celiac disease, your doctor may recommend a skin medication (dapsone) along with the gluten-free diet.

Refractory celiac disease

If you have refractory celiac disease, you may continue to have severe symptoms, or your symptoms may lessen but then relapse. In either case, your small intestine does not heal. When this happens, you likely will require evaluation in a specialized center. Refractory celiac disease can be quite serious and there is currently no proven treatment.

People with refractory celiac disease should be treated by experts. There may be several causes for this condition. Doctors will often use steroid therapy — either a topical budesonide or systemic steroids such as prednisone. Sometimes, they will use the same medications used to treat other conditions.

Potential future treatments

While the only proven therapy for celiac disease is a gluten-free diet, it is not perfect. People with celiac disease may often be accidentally exposed to gluten, possibly causing severe symptoms.

Several treatments are in development for celiac disease. Some try to neutralize or bind to gluten. Others address the barrier of the intestine, blocking the leakiness that gluten can trigger. Still others target the body's immune system. Researchers have also been trying to genetically modify wheat, but have not yet been successful.

None of these treatments is likely to be approved within the next two to three years. However, given the number of different approaches, there is a good chance that there will be additional treatments available for celiac disease in the future.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

If you've been diagnosed with celiac disease, you'll need to avoid all foods that contain gluten. Ask your doctor for a referral to a dietitian, who can help you plan a healthy gluten-free diet. It's important to get enough vitamins, nutrients, fiber and calcium in your diet.

Here's an overview of foods that contain gluten and gluten-free foods that are safe to eat.

Always avoid

Avoid food and drinks containing:

  • Barley
  • Bulgur
  • Durum
  • Farina
  • Graham flour
  • Malt
  • Rye
  • Semolina
  • Spelt (a form of wheat)
  • Triticale
  • Wheat

Read labels

Packaged foods should be avoided unless they're labeled as gluten-free or have no gluten-containing ingredients. In addition to cereals, pastas and baked goods — such as breads, cakes, pies and cookies — other packaged foods that may contain gluten include:

  • Beer
  • Candies
  • Gravies
  • Imitation meats or seafood
  • Processed luncheon meats
  • Salad dressings and sauces, including soy sauce
  • Self-basting poultry
  • Soups

Certain grains, such as oats, can be contaminated with wheat during growing and processing. Pure oats are not harmful for most people with celiac disease. In the United States, doctors generally recommend avoiding oats unless they have been specifically labeled gluten-free. Outside of the United States, different labeling laws for oats apply. Occasionally, even pure oats can be a problem for people with celiac disease.

Allowed foods

Many basic foods are allowed in a gluten-free diet, including:

  • Fresh meats, fish and poultry that aren't breaded, batter-coated or marinated
  • Fruits
  • Most dairy products
  • Potatoes
  • Vegetables
  • Wine and distilled liquors, ciders and spirits

Grains and starches allowed in a gluten-free diet include:

  • Amaranth
  • Arrowroot
  • Buckwheat
  • Corn
  • Cornmeal
  • Gluten-free flours (rice, soy, corn, potato, bean)
  • Pure corn tortillas
  • Quinoa
  • Rice
  • Tapioca

Carob is a potential substitute for gluten, but more research is needed about its effect on people with celiac disease.

Fortunately for bread and pasta lovers with celiac disease, an increasing number of gluten-free products are available. If you can't find any at your local bakery or grocery store, check online. There are gluten-free substitutes for many gluten-containing foods. However, be aware that processed gluten-free foods may contain excessive fat and calories.

Alternative medicine

There are no proven treatments that assist with celiac disease. Enzyme therapies that claim to digest gluten may be available in health food stores or other outlets, but there is no scientific evidence that they are effective in treating celiac disease.

Coping and support

It can be difficult, and stressful, to follow a completely gluten-free diet. Here are some ways to help you cope and to feel more in control.

  • Get educated. Educate those around you — including family and friends — so they can recognize, acknowledge and support your efforts in dealing with the disease.
  • Follow your doctor's recommendations. If you are diagnosed with celiac disease, it's necessary to maintain a totally gluten-free diet.
  • Find a support group. It's helpful to know that you're not alone. You may find comfort in sharing your experience and struggles and meeting people who face similar challenges. Organizations such as the Celiac Disease Foundation, Gluten Intolerance Group, the Celiac Support Association and Beyond Celiac can help put you in touch with others who have had similar experiences and can understand what you're going through.

Preparing for your appointment

You may be referred to a doctor who treats digestive diseases (gastroenterologist).

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What can you do

  • Continue eating a normal diet. If you stop or reduce eating gluten before you're tested for celiac disease, you may change the test results.
  • Write down your symptoms. Include when they started and how they may have changed over time.
  • Write down key personal information. Include any major stresses or recent life changes.
  • Make a list of all medications. Include vitamins or supplements that you're taking.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Is my condition temporary or long term?
  • What kinds of tests do I need?
  • What treatments can help?
  • Are there any dietary restrictions that I need to follow?
  • How will I learn which foods contain gluten? Should I see a dietitian?
  • If I have celiac disease, will you also test for other conditions such as vitamin or mineral deficiencies, osteoporosis or diabetes?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer questions your doctor may ask:

  • When did you first begin experiencing symptoms, and how severe are they?
  • Have your symptoms been continuous or occasional?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?
  • What medications and pain relievers do you take?
  • Does anyone in your family have celiac disease?
  • Do you or does anyone in your family have an autoimmune disorder?
  • Have you had any blistering or itchy skin rashes with your symptoms?
  • Have you ever been diagnosed with anemia or osteoporosis?

Celiac disease care at Mayo Clinic

July 29, 2017
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