Celiac Disease Clinic

Celiac disease is a chronic digestive disorder affecting a growing number of people in the United States. UC San Diego Health System is dedicated to providing the prompt diagnosis and nutritional counseling needed to address this autoimmune disease. To meet the clinical needs of people with celiac disease, we run a pediatric celiac disease clinic, directed by Dr. Kimberly Newton, and an adult celiac disease clinic, directed by Dr. Sheila Crowe.

Celiac disease occurs in genetically susceptible individuals. This multisystem disorder is caused by the body's immune system reacting to proteins in wheat, rye and barley. The immune reaction damages the lining of the small intestine, causing reduced nutrient absorption. When the intestinal villi in the small intestine are damaged, people do not absorb critical vitamins, minerals and calories. This condition continues as long as these proteins are in the diet.

Celiac disease can occure at any time in a person’s life. The disease occurs in approximately one in 100 people in the United States, yet only a small percentage of individuals with celiac disease are diagnosed. Current estimates are that there are more than two million people in the United States with celiac disease who have not been diagnosed.

Risk Factors

The main risk factor is having a family member with celiac disease. The disease can affect anyone, but it tends to be more common in those with existing autoimmune diseases, such as autoimmune liver disease, type 1 diabetes, rheumatoid arthritis or autoimmune thyroid disease.

Symptoms

Symptoms of celiac disease can occur in the digestive system or in other parts of the body. From person to person, symptoms can vary a great deal and can make a definitive diagnosis difficult. One person may have depression, irritability or fatigue, while another may have diarrhea, constipation, gas, bloating or abdominal pain. These symptoms can also sometimes first appear after an episode of gastroenteritis, severe emotional distress, abdominal surgery, pregnancy or childbirth.

Look for any of the following symptoms:

• Bloating, gas or abdominal pain
• Constipation or diarrhea
• Significant unexplained weight loss
• Chronic fatigue and weakness
• Unexplained anemia
• Recurrent gas, bloating and abdominal pain
• Premature onset of osteoporosis
• Itchy skin rash with small blisters
• Irritability or behavior change
• Mouth ulcers
• Tingling or numbness in hands or feet
• Migraine headaches

Diagnosis

While celiac disease primarily affects the gastrointestinal tract, it is now recognized that the condition can affect other organ systems without showing noticeable gastrointestinal symptoms. This makes diagnosing celiac disease challenging.

Several blood tests are available to test for celiac disease. The blood tests measure for certain antibodie, including IgA tissue transglutaminase antibody (also known as tTG antibody), IgA anti-endomysial antibody, anti-gliadin antibodies IgA and IgG (in younger children) and antibodies to deamidated gliadin. If the tests reults are positive, an upper endoscopy is performed to get a biopsy from the first part of the small intestine (duodenum). The biopsy is required to establish a definite diagnosis of celiac disease. Sometimes the symptoms are so pronounced that an endoscopy and biopsy is performed even if the celiac disease antibody test results are negative.

You should not start a gluten-free diet before you are diagnosed. This is because the damage to the small intestine that is caused by gluten in people with celiac disease is reversible and eliminating gluten from the diet before the biopsy is performed can interfere with obtaining accurate test results.

Celiac disease is not the same as a wheat allergy or glutensensitivity without intestinal damage. The hereditary nature of the disease and the risk of nutritional deficiencies, other autoimmune diseases and GI cancers make it important for a person to be properly diagnosed. Read more about the differences between these conditions and diseases at the American Celiac Disease Alliance.

Treatment

Currently, treatment for celiac disease involves follwing a lifelong gluten-free diet, similar to those with wheat allergies. This means strictly avoiding wheat, barley and rye. Gluten can be found in foods, drinks and medications. Maintaining a gluten-free diet can be challenging and life altering. At the Celiac Disease Clinics, our specialists provide tailored nutritional counseling to help you to find foods that are satisfying and healthy. We work closely to provide you with recipes, tips for dining out and useful information on staying gluten-free.

UC San Diego Health System Expertise

In addition to advanced diagnostic techniques and nutritional counseling, UC San Diego Health System provides opportunities for you to participate in clinical trials examining new treatment options for celiac disease. Read more about our research and clinical trials, and visit the UCSD’s Wm. K. Warren Medical Research Center for Celiac Disease.

Research indicates that adults with celiac disease who are members of a celiac support system are more likely to successfully adhere to a gluten-free diet. The Warren Celiac Center encourages the community to participate in local support group activities, including meetings for parents of children with celiac disease, teen events, mentorship programs and other special events. Find out more at Wm. K. Warren Medical Research Center for Celiac Disease.