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Celiac disease
Overview Symptoms & causes Diagnosis & treatment Selfmanagement More about
Symptoms and causes
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The signs and symptoms of celiac disease can vary greatly and are dif
ferent in children and
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adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may Policy Opportunities
also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.
However, more than half of adults with celiac disease have signs and symptoms that are not Mayo Clinic Store
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Children
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In children under 2 years old, typical signs and symptoms of celiac disease include:
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Vomiting Research
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Chronic diarrhea
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Swollen belly appointment
Failure to thrive
Poor appetite
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Muscle wasting
Older children may experience:
Diarrhea
Constipation
Weight loss
Irritability
Short stature
Delayed puberty
Neurological symptoms, including attentiondeficit/hyperactivity disorder (ADHD),
learning disabilities, headaches, lack of muscle coordination and seizures
Dermatitis herpetiformis
Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten
intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.
Dermatitis herpetiformis is often associated with changes to the lining of the small intestine
identical to those of celiac disease, but the disease may not produce noticeable digestive
symptoms.
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Doctors treat dermatitis herpetiformis with a glutenfree diet or medication, or both, to
control the rash.
When to see a doctor
Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two
weeks. Consult your child's doctor if your child is pale, irritable or failing to grow or has a
potbelly and foulsmelling, bulky stools.
Be sure to consult your doctor before trying a glutenfree diet. If you stop or even reduce the
amount of gluten you eat before you're tested for celiac disease, you may change the test
results.
Celiac disease tends to run in families. If someone in your family has the condition, ask your
doctor if you should be tested. Also ask your doctor about testing if you or someone in your
family has a risk factor for celiac disease, such as type 1 diabetes.
Causes
Celiac disease occurs from an interaction between
genes, eating foods with gluten and other environmental
factors, but the precise cause isn't known. Infant feeding
practices, gastrointestinal infections and gut bacteria
might contribute to developing celiac disease.
Sometimes celiac disease is triggered — or becomes
active for the first time — after surgery
, pregnancy,
childbirth, viral infection or severe emotional stress.
Celiac disease
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When the body's immune system overreacts to gluten in
food, the reaction damages the tiny
, hairlike projections
(villi) that line the small intestine. V
illi absorb vitamins, minerals and other nutrients from the
food you eat. If your villi are damaged, you can't get enough nutrients, no matter how much
you eat.
Some gene variations appear to increase the risk of developing the disease. But having
those gene variants doesn't mean you'll get celiac disease, which suggests that additional
factors must be involved.
The rate of celiac disease in Western countries is estimated at about 1 percent of the
population. Celiac disease is most common in Caucasians; however
, it is now being
diagnosed among many ethnic groups and is being found globally
.
Risk factors
Celiac disease can affect anyone. However, it tends to be more common in people who
have:
A family member with celiac disease or dermatitis herpetiformis
Type 1 diabetes
Down syndrome or Turner syndrome
Autoimmune thyroid disease
Microscopic colitis (lymphocytic or collagenous colitis)
Addison's disease
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Rheumatoid arthritis
Complications
Untreated, celiac disease can cause:
Malnutrition. The damage to your small intestine means it can't absorb enough
nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can
cause slow growth and short stature.
Loss of calcium and bone density. Malabsorption of calcium and vitamin D may
lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone
density (osteoporosis) in adults.
Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to
reproductive issues.
Lactose intolerance. Damage to your small intestine may cause you to experience
abdominal pain and diarrhea after eating lactosecontaining dairy products, even
though they don't contain gluten. Once your intestine has healed, you may be able to
tolerate dairy products again. However
, some people continue to experience lactose
intolerance despite successful management of celiac disease.
Cancer. People with celiac disease who don't maintain a glutenfree diet have a
greater risk of developing several forms of cancer
, including intestinal lymphoma and
small bowel cancer.
Neurological problems. Some people with celiac disease may develop neurological
problems such as seizures or peripheral neuropathy (disease of the nerves that lead to
the hands and feet).
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In children, celiac disease can also lead to failure to thrive, delayed puberty
, weight loss,
irritability and dental enamel defects, anemia, arthritis, and epilepsy
.
Nonresponsive celiac disease
As many as 30 percent of people with celiac disease may not have, or be able to maintain,
a good response to a glutenfree diet. This condition, known as nonresponsive celiac
disease, is often due to contamination of the diet with gluten. Therefore it's important to work
with a dietitian.
People with nonresponsive celiac disease may have additional conditions, such as bacteria
in the small intestine (bacterial overgrowth), microscopic colitis, poor pancreas function,
irritable bowel syndrome or intolerance to disaccharides (lactose and fructose). Or
, they
may have refractory celiac disease.
Refractory celiac disease
In rare instances, the intestinal injury of celiac disease persists and leads to substantial
malabsorption, even though you have followed a strict glutenfree diet. This combination is
known as refractory celiac disease.
If you continue to experience signs and symptoms despite following a glutenfree diet for six
months to one year, your doctor may recommend further testing and look for other
explanations for your symptoms. Y
our doctor may recommend treatment with a steroid to
reduce intestinal inflammation, or a medication that suppresses your immune system. All
patients with celiac disease should be followed up to monitor the response of their disease
to treatment.
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