What Are the Symptoms of Celiac Disease in Adults?

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Celiac disease (also called gluten-sensitive enteropathy, celiac sprue, or non-tropical sprue) is an autoimmune condition in which the immune system responds abnormally to a protein called gluten, leading to damage of the lining of the small intestine, which is responsible for absorbing food and nutrients. Damage to the lining of the small intestine can lead to malabsorption. 

Gluten is a protein found in wheat, rye, barley, and many prepared foods. 

Symptoms of celiac disease in adults include:

• Diarrhea
• Weight loss
• Abdominal discomfort
• Excessive gas
• Bloating
• Constipation
• Signs and symptoms caused by vitamin and nutrient deficiencies 

Because people with celiac disease may not be absorbing nutrients adequately, other medical conditions may occur, including:

• Osteopenia or osteoporosis 
• Iron deficiency anemia 
• Diabetes mellitus 
• Thyroid problems: usually underactive thyroid (hypothyroidism) 
• Dermatitis herpetiformis, a skin condition that causes blisters 
• Nervous system disorders
• Liver disease

The cause of celiac disease is unknown but it is believed to be a result of a combination of environmental and genetic factors. 

Celiac disease is more common in Europe, North and South America, Australia, North Africa, the Middle East, and in South Asia, and occurs rarely in people from other parts of Asia or sub-Saharan Africa.

Celiac disease is diagnosed with the following tests: 

• Blood tests 
  • Complete blood count (CBC)
  • Lipid levels (total cholesterol, HDL, LDL, and triglycerides)
  • Thyroid levels
  • Antibody levels 
    • cIgA tissue transglutaminase, or IgA tTG
    • IgA 
    • IgG deamidated gliadin peptide
  • Nutritional deficiencies 
    • Iron
    • Folic acid
    • Vitamin B12
    • Vitamin D
• Small intestine biopsy 
• Bone density (DEXA) scan 

The mainstay of treatment for celiac disease is a gluten-free diet. Gluten is a group of proteins found in wheat, rye, and barley, and is also a hidden ingredient in many prepared and processed foods as well as medications and supplements. 

A dietitian experienced in celiac disease can help patients learn about a gluten-free diet, what foods to avoid, and what foods to eat to maintain nutritional balance. They can also advise on nutritional supplements that may be needed. It is important for people with celiac disease to strictly adhere to a gluten free diet because even small amounts of gluten can aggravate symptoms. 

General tips for gluten-free diets: 

• Avoid foods that contain wheat, rye, barley, malt, brewer's yeast, oats (unless labeled gluten-free), and yeast extract and autolyzed yeast extract (unless labeled gluten-free).
• Naturally gluten-free foods include rice, wild rice, corn, potato, and other grains.
  • Some naturally gluten-free foods may be contaminated with wheat, barley, or rye so people with celiac disease need to choose labeled gluten-free versions of these products. 
  • Exceptions are fresh corn, fresh potatoes, plain rice, and wild rice. 
  • Unless they are labeled gluten-free, dried beans, lentils, and other legumes, such as chick peas, are allowed by law to contain a certain percentage of foreign grain, including wheat, barley, and/or rye. 
• Consuming whole grains labeled gluten-free (quinoa, amaranth, teff, buckwheat, sorghum, and millet) can help prevent constipation and increase nutrient intake. 
• Include fruits, vegetables, nuts and seeds, legumes and beans (navy, pinto, black, cannellini, etc.) in the diet for fiber and nutrients. 
• If a food is FDA regulated, the word "wheat" will be included on the label of the product if it contains wheat protein. If you do not see any of the following words on the label of an FDA-regulated food (wheat, rye, barley, malt, brewer's yeast, oats, yeast extract, and autolyzed yeast extract), the product is unlikely to include gluten ingredients. However, wheat protein may be in a product unintentionally due to cross-contact.
• Distilled alcoholic beverages, vinegars, and wine are gluten-free unless gluten-containing flavorings are added after production. Malt beverages such as beer are not considered gluten-free (other than specially-produced gluten-free beers labeled as such).
• Some people with celiac disease may be unable to tolerate dairy products. Choose lactose-reduced or lactose-free products or gluten-free, dairy-free alternatives, such as rice, soy, or nut (almond, hazelnut) beverages enriched with calcium and vitamin D.

Complications of celiac disease include: 

• Nonresponsive celiac disease (about 10% of patients), in which symptoms continue despite adhering to a gluten-free diet
• Refractory celiac disease, in which intestinal symptoms do not improve despite a strict gluten-free diet, or symptoms that initially improve with dietary changes but then return
• Ulcerative jejunitis, which is multiple ulcers in the small intestine that do not heal
• Skin conditions such as dermatitis herpetiformis, which is characterized by intensely itchy, raised, fluid-filled areas on the skin, usually located on the elbows, knees, buttocks, lower back, face, neck, trunk, and sometimes within the mouth
• Vitamin or nutrient deficiencies such as anemia due to iron deficiency or bone loss due to vitamin D deficiency 
• Untreated celiac disease can increase the risk of developing certain types of gastrointestinal cancer
• Lymphoma (uncommon)