Celiac disease is an autoimmune disease in which the ingestion of gluten results in inflammation of the small intestine. This inflammation interferes with the absorption of nutrients and causes many different symptoms. Sometimes, patients can go without symptoms but there are other signs of absorption problems on labs including, but not limited, to iron deficiency or liver test abnormalities. Approximately one percent of the general population is affected by celiac disease, although this varies based on ethnicity. Why celiac disease occurs in certain individuals and not others is due to a combination of genetic and environmental factors.
The University of Michigan Health Celiac Disease Program was founded in 2015 to diagnose and treat those with celiac disease and gluten/wheat sensitivity. Our multidisciplinary team of gastroenterologists and subspecialists in areas such as dermatology, neurology, thyroid disease and other disorders associated with celiac disease aims to provide the highest levels of comprehensive care to our patients. The Celiac Disease Program also aims to raise awareness of celiac disease and gluten sensitivity to both physicians and the public as well as engage in cutting-edge research. We look forward to working with you!
Celiac Disease Symptoms
There is a wide range of symptoms and signs that patients with celiac disease experience. Some of the more common ones include diarrhea, bloating, abdominal pain, weight loss, growth issues in children and anemia. Others include constipation, early onset bone disease, infertility, amenorrhea, fatigue, vitamin deficiencies, neuropathy and dermatitis herpetiformis (a type of rash associated with celiac disease).
It can be difficult to differentiate celiac disease from gluten sensitivity or other digestive conditions based on symptoms alone, which is why an evaluation with one of our experienced physicians is necessary.
How Celiac Disease Is Diagnosed
Blood tests are usually sent to check for specific celiac disease antibodies. This may be followed by an upper endoscopy with biopsy of the small intestine to confirm the diagnosis.
An upper endoscopy may still be recommended if the blood test is negative, as a small percentage of people with celiac disease can have a negative blood test. Throughout this entire process, it is important to continue to ingest gluten so that the results are as accurate as possible. This is because the labs may be falsely negative if the GI tract is not exposed to gluten to create an immune system response.
Treatment Options
The current treatment for celiac disease is a strict and lifelong gluten-free (GF) diet. In most cases, individuals with celiac disease will have a marked improvement in their symptoms on a gluten-free diet.
However, for patients who continue to have symptoms despite their belief that they are being compliant with a GF diet, there are additional options:
- Consulting with our physicians, who have expert knowledge on the complications of celiac disease, including refractory celiac disease, ulcerative jejunitis and lymphoma.
- Consulting with our dietitians, who can help recognize obscure sources of gluten contamination (the most common cause of persistent symptoms in patients with celiac disease)
- Scheduling capsule endoscopy and balloon endoscopy procedures
- Consulting with our radiology department, which has specialized imaging including CT enterography and MR enterography to diagnose celiac disease complications
- Consulting with our physiology lab, which has the ability to perform breath testing for both carbohydrate intolerance and bacterial overgrowth
- Consulting with our expert GI pathologists, who have all the diagnostic tools necessary to confidently make the diagnosis of refractory celiac disease or lymphoma
- Prescribing immunosuppressive medications for complications of celiac disease
Role of Gluten-Free Diet in Patients without Celiac Disease
Although many patients experience symptoms of celiac disease when ingesting gluten-containing products, only a minority of these have true celiac disease on testing. Sometimes this scenario is called Non-Celiac Gluten Sensitivity (NCGS). The role for recommending a gluten-free diet in these patients is controversial. Furthermore, strict adherence to a gluten-free diet without celiac disease can be costly and lead to unnecessary restriction of nutrients such as whole grains, which are important for cardiovascular health.
While research continues to emerge, there is decent evidence to suggest that these patients develop symptoms not from gluten itself but from other components of wheat, including poorly digested sugar molecules called fructans. Restricting fructans is part of the now popular low FODMAP diet used for patients with irritable bowel syndrome. While this diet is evidence-based to reduce symptoms in some patients with irritable bowel syndrome, it is quite restrictive and is NOT designed to be a forever diet plan. Thus, our specialized GI dietitians can help you identify possible fructans (or other FODMAPs) in your diet and guide you through a structured protocol to determine the components that trigger your symptoms.
Our Team
Our GI team includes physicians, dietitians, and a behavioral psychologist who all work together to provide comprehensive care for our patients. Our highly trained physicians provide the initial clinical evaluation in order to make the diagnosis of celiac disease/gluten insensitivity. Once the diagnosis is made, they will continue to monitor closely for ongoing symptoms and possible complications. Our specialized dietitians also play an integral role in patient care, providing an in-depth education on the gluten-free (GF) diet. We know that celiac disease/gluten sensitivity can be accompanied by a variety of psychosocial effects, such as social isolation from following a special diet and difficulty in coping with a lifelong illness. For this reason, our team also includes a behavioral psychologist to help manage these effects.
Research
The U-M Health Division of Gastroenterology has a long tradition of basic laboratory and clinical research excellence. Since the division's beginning in 1947, U-M has provided national leadership in gastroenterology. Our division has consistently been among the top centers funded by the National Institutes of Health.
With the addition of the Celiac Disease Program to our division, we hope to continue that tradition of excellence in research in this unique population of patients.
Additional Resources
Make an Appointment
To schedule a clinic visit to discuss celiac disease or another gastrointestinal disorder, call the U-M Health Gastroenterology Call Center at 888-229-7408 or visit the GI Make an Appointment page for more information.