Celiac disease is an immune reaction to gluten, a protein in wheat, barley and rye, that damages the lining of the small intestine. The damage reduces absorption of nutrients, and a strict gluten-free diet lets the gut heal.
Key symptoms
- Chronic diarrhea, bloating and gas
- Weight loss or poor growth in children
- Tiredness from iron deficiency anemia
- Itchy blistering rash on elbows and knees (dermatitis herpetiformis)
- Sometimes only constipation or no gut symptoms at all
What you find on exam
- Weight, height and growth chart in children
- Pale skin or mouth ulcers
- Bloated abdomen
- Rash typical of dermatitis herpetiformis
Tests
- Tissue transglutaminase IgA antibody with total IgA level, while still eating gluten
- Upper endoscopy with small bowel biopsies to confirm
- Blood count, iron, folate, vitamin D and liver tests
- Bone density scan in adults at diagnosis if risk is high
Treatment basics
- Lifelong strict gluten-free diet
- Referral to a dietitian
- Replace iron, folate, calcium and vitamin D as needed
- Recheck antibodies to confirm the diet is working
Red flags
- Severe weight loss or dehydration
- Ongoing symptoms despite a strict gluten-free diet
- New abdominal pain, bleeding or obstruction suggesting lymphoma
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.