Hello. My name is Joe Murray. I'm a gastroenterologist here at the Mayo Clinic in Rochester, Minnesota. Today I'm talking to you about celiac disease. Celiac disease is a condition that affects primarily the small intestine. It is a reaction to proteins in wheat, barley and rye, which are sometimes termed gluten. Now what does this mean? You've probably heard of gluten from the media or reading about it in magazines. Well, gluten as a protein, when it contacts the intestine of somebody with celiac disease, it causes damage. And the damage which is the result of our body rejecting gluten, causes damage to the villi. These are little finger-like projections that line the small intestine. When this happens, at least at the beginning, there are no symptoms. And that can go on for many years. A person can have celiac disease, not know they have it, and basically have no symptoms. But then over time they can start to develop problems. The most common problem is a failure to absorb nutrients, particularly iron. So iron deficiency anemia is one of the most common consequences of this disease. What's peculiar about this is that the person develops anemia and then they take iron excess iron to try and treat it. They may not be able to absorb that either. And so that's often the first clue that somebody has this. If it becomes more severe, it can cause diarrhea, weight loss, abdominal pain, bloating, gaseousness, what we call flatulence, the abdomen can become distended, especially after meals. If it occurs in children, it can affect growth and development of the child.

Now this disease was once considered very rare, but in the last probably 10 to 15 years it has become quite common. It's now being diagnosed 20 times as often as it was 30 years ago. Why is this happened? We really don't know. Some people think it might be due to a change in what we're eating or the types of foods we're eating. But really we have no idea why this increase has occurred. This increase parallels other immune diseases like type 1 diabetes and allergy disorders.

So how do we find this disease and how is it diagnosed? Well, the first test is usually a blood test. So there are antibodies that can be detected in the blood by a simple blood test. If those antibodies are positive, it indicates a high possibility of celiac disease. And then the patient usually should be referred to a gastroenterologist who will undertake an endoscopy, basically putting a tube down into the small intestine, taking some tiny pinches of tissue to test. That usually confirms the diagnosis. Now while that — it sounds pretty simple or straightforward — it can be complicated. And it's complicated, especially if somebody reduces or eliminates gluten from their diet before testing. And that can be a real challenge because the blood tests may become negative and the biopsy may normalize. So what do we do in that circumstance? Well, if the patient's been on a gluten-free diet for a year or more, it's likely that the blood tests will not be helpful. Even a biopsy may not be helpful at that time. So we do a genetic test. Now this genetic test is really helpful if the person doesn't have the genes for celiac disease. And if they don't have those genes, it makes the disease extremely unlikely to be present, and then should direct the patient and their doctor elsewhere. If they carry the genes for celiac disease, it doesn't prove they have the disease, but it means it's possible. And in that case then we often do what's called a gluten challenge, where we have to reintroduce gluten into the patient's diet and see if it produces symptoms, abnormalities on blood tests, and ultimately, can we prove it with damage on biopsies taken from the intestine.

So how many people have this disease? It's probably one in a hundred people have this disease. So the numbers vary a little. Some parts of the world have more and some less. Even in the United States, there's more celiac disease in the northern part of the United States than in the Southern states. Why that is we don't know, but it parallels other immune disorders. For example, MS seems to be more common in northern states than in southern states.

Are there complications of this condition? There can be. It's not just the symptoms I talked about: anemia and GI or digestive symptoms. It can also cause complications that can affect bone health. And sometimes we see people presenting with what we call fragile bone fractures here, from bone fragility, from osteoporosis or a bone softening known as osteomalacia. And in rare patients, it can increase the risk of certain rare malignancies, such as lymphoma or small bowel cancers. So this is not a trivial disease and it shouldn't be mixed up with people who are simply avoiding gluten for lifestyle reasons, so-called, your people who are gluten avoiders. That's not what celiac disease is. Celiac disease can be a serious illness causing substantial injury in the digestive tract and beyond the digestive tract.

Probably most challenging for celiac disease, are people who don't have any digestive complaints at all. And they present with problems such as infertility, skin rashes, recurring mouth ulcers, hair loss for example, the bone problems. We've talked about, chronic fatigue symptoms that are not at all specific for celiac disease, but can often be a significant consequence of this hidden condition. Thank you for watching.