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Food and Nutrition

Celiac Disease

Celiac disease or gluten-sensitive enteropathy is an inherited condition triggered by the consumption of cereal grains containing "gluten". Simply put, the immune system of a celiac reacts negatively to the presence of gluten in the diet causing damage to the inner lining of the small bowel which reduces the person's ablility to absorb nutrients including: iron, folate, calcium, Vitamin D, protein, fat and other food compounds. The grains considered to be capable of producing negative effects in individuals with celiac disease include the different species of wheat (e.g., durum, spelt, kamut), barley, rye, and their cross-bred hybrids (e.g., triticale, which is a cross between wheat and rye). Currently the only treatment for celiac disease is to continually maintain a strict gluten-free diet. This disease affects nearly 1% of the population.

Closely related family members of celiacs have a greater risk of developing the disease. However, not all individuals carrying the genes identified with this disease will develop the disease. Therefore, other genetic and environmental factors have also been implicated in its development.

The symptoms of celiac disease vary greatly from one person to another both in extent and seriousness, making diagnosis difficult. Infants and children more often display symptoms of diarrhea and abnormal stretching of the abdomen. They could also show symptoms of malnutrition such as short stature, anemia (weakness or low stamina), defects in teething, failure to thrive, or in developmental delay. In adults, gastrointestinal complaints are common and include abdominal pain, flatulence, and diarrhea. Weight loss is most common, but symptoms of weight gain and constipation are not unheard of. Only some individuals with celiac disease suffer typical gastrointestinal symptoms, while others may display no visible symptoms. Further symptoms vary and can include mouth ulcers, extreme fatigue, bone pain and others. A serious skin condition (called dermatitis herpetiformis) that results in an itchy rash with bumps and blisters is sometimes a result of this disease. This condition is linked to gluten sensitivity, and skin biopsy (sampling and testing) is usually performed to confirm diagnosis.

Other conditions associated with celiac disease include type 1 diabetes, down syndrome, thyroiditis, arthritis, ataxia, depression, and neuropathy.

If celiac disease is diagnosed early and treated with a gluten-free diet, the damaged tissues can heal and the risk of developing many of the long term complications of this disease, including osteoporosis (a weakening of the bones), lymphoma (tumors arising in the lymph nodes), and infertility can be reduced.

Diagnosis

In recent years, an improvement in the overall level of awareness about celiac disease and associated conditions has allowed individuals and health professionals to better suspect and screen for celiac disease. This is particularly true for those groups at high risk.

Celiac disease can be diagnosed through a combination of:

  • Blood tests
  • Small-bowel biopsy
  • Recovery from the symptoms while following a gluten-free diet

Small-bowel biopsy remains the 'gold standard' test for celiac disease detection. Testing for the disease should take place before an individual starts a gluten-free diet, since removal of gluten from the diet would interfere with a practitioner's ability to detect the disease. After 6 to 12 months of maintaining a strict gluten-free diet, symptoms should disappear, blood tests for the disease should become negative, and any small bowel injury should heal completely. It will be important for celiac patients to regularly follow up with their family doctor on their progress in treating the disease.

For more information on celiac disease

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