Celiac disease, commonly known as celiac sprue, is a chronic inflammatory disease of the small intestine. The disease is triggered by dietary exposure to gluten, a protein found in wheat, barley and rye. When affected individuals ingest foods containing gluten, the lining (mucosa) of the intestine becomes damaged by the body's immune response. When the lining of the intestine is damaged, it cannot absorb water, vitamins and nutrients and cannot make enzymes that are critical to aid in digestion. This can result in weight loss, diarrhea and nutrient deficiencies.

For more information or to schedule an appointment with a gastroenterologist, call (206) 223-2319.

Symptoms of Celiac Disease

Signs and symptoms of celiac disease may vary in type and intensity. The most common signs and symptoms are:

Diagnosing Celiac Disease

Your gastroenterologist may suspect celiac disease based on your medical history and a review of your symptoms, and will have you undergo several tests and procedures to help determine a diagnosis. These tests and procedures include:

• BLOOD TESTS — Blood tests are taken to test blood for higher than normal levels of certain autoantibodies, or proteins that react against gluten and the enzymes  that process gluten. To diagnose celiac disease, doctors will test your blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.
   
  Before being tested, you should continue to eat foods with gluten, such as breads and pastas. If you stop eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.
   
• SMALL INTESTINAL BIOPSY — If blood tests and symptoms suggest celiac disease, a biopsy of your small intestine is performed to confirm the diagnosis. The lining of your small intestine usually consists of fingerlike projections called villi. The villi contain digestive enzymes and provide the large absorptive surface of the small intestine. In celiac disease, the villi are destroyed because of the inflammatory and autoimmune process. Once the villi are destroyed, nutrients cannot be absorbed well. Biopsy samples of the small intestine may show mild, moderate, or severe destruction of the villi depending on the severity of your inflammation.
   
  During the biopsy, your doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi. Biopsy samples of your small intestine are obtained by introducing a small, flexible endoscope through the mouth, the stomach, and into your small intestine while you are sedated.

Treating Celiac Disease

Currently, the only treatment for symptoms of celiac disease is following a gluten-free diet. Patients with celiac disease often are at risk of malnutrition from the loss of nutrients as foods and liquids make their way through the digestive tract. Specialists within the Digestive Disease Institute at Virginia Mason help patients manage all aspects of their care, including nutritionists to help with nutritional needs.

A nutritionist also can answer questions about what foods and liquids to avoid, such as those that contain wheat, barley and rye. Your health care provider may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be prescribed for short-term use or if you have celiac disease that does not respond to treatment.

For most celiac patients, following a strict gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent future damage. For more treatment information or to schedule an appointment with a gastroenterologist, call (206) 223-2319.