Celiac disease

Celiac disease is a systemic autoimmune disease with gastrointestinal symptoms as well as multiple, but variable, non-gastrointestinal symptoms. Signs and symptoms may begin from early childhood to adulthood. In adults, the age at diagnosis is usually between 30 and 50. On average, the time between the first symptoms and diagnosis is about 11 years due to the wide range of non-specific symptoms and lack of symptoms in some people.

Gastrointestinal symptoms of celiac disease may include chronic or recurrent diarrhea; malabsorption; abdominal pain and distention; bloating; vomiting; and weight loss. People with mild to severe gastrointestinal symptoms are usually said to have 'classic celiac disease.'

Non-gastrointestinal symptoms of celiac disease may include dermatitis herpetiformis; chronic fatigue; joint pain/inflammation; iron-deficiency anemia; migraines; depression; attention-deficit disorder; epilepsy; osteoporosis/osteopenia; infertility and/or recurrent miscarriage; vitamin deficiencies; short stature; failure to thrive; delayed puberty; dental enamel defects; and various secondary autoimmune disorders. People without prominent gastrointestinal symptoms are often said to have 'nonclassic celiac disease,' which is more common than classic celiac disease. Iron-deficiency anemia is the most common finding of nonclassic celiac disease, and may be the only finding.

Some affected people have no symptoms (often identified because of an affected family member or screening) and are said to have 'silent celiac disease.'^[1]

Celiac disease causes inflammation of the small bowel, damage to the villi (small, finger-like projections that protrude from the lining of the intestinal wall), and subsequent malabsorption of nutrients.^[1] Inflammation in the gastrointestinal (GI) tract causes many of the classic GI symptoms of celiac disease. This inflammation damages the villi, causing them to become shortened and flattened, thus unable to effectively absorb nutrients. The inflammation as well as poor nutrient absorption may lead to the non-GI signs and symptoms of celiac disease.^[2] However, the exact underlying causes of the non-GI symptoms are not well understood.^[1]

The long-term outlook (prognosis) for people with celiac disease can vary because some people have no symptoms, while others have severe malabsorption features. Overall, people with untreated or unresponsive celiac disease have increased early mortality compared to the general population.^[1] Without diagnosis and treatment, celiac disease is ultimately fatal in 10 to 30% of people. Currently this outcome is rare, as most people do well if they avoid gluten.^[3]

Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3-6 months in children and may take 2-3 years in adults. In rare cases there can be long-term damage to the lining of the intestines before the diagnosis is made.^[4] Strictly adhering to a gluten-free diet also significantly decreases the risk of cancer.^[3]