Celiac disease: how it’s diagnosed

As many as 1 in 141 Americans has celiac disease, but most remain undiagnosed, according to the National Institutes of Health. This is partly because the immune disorder is associated with a long list of symptoms and can be mistaken for other diseases. But there are ways to diagnose celiac disease.

People with celiac disease can’t tolerate gluten because it damages their small intestine and their bodies don’t absorb key nutrients. Gluten is a protein that’s found in wheat, rye and barley, so people with celiac disease need to follow a gluten-free diet to avoid intestinal inflammation and long-lasting damage.

Similarities to other conditions

Some of the more common symptoms of celiac disease are abdominal bloating, constipation, gas and stomach pain. But there are many other possible symptoms as well, and celiac can be mistaken for other conditions, including:

Irritable bowel syndrome

Lactose intolerance

Inflammatory bowel disease

Diverticulitis

Intestinal infections

Chronic fatigue syndrome

How celiac disease is diagnosed

If you think you have celiac disease, your health care provider may require one or more of the following:

Medical and family history: Your provider will review your medical records and history, and will want to know whether your family has a history of celiac disease.

Physical Exam: In the case of celiac disease, your provider will be looking for signs of malnutrition, bloating and pain in your abdomen, or a rash associated with celiac.

Blood tests: Your blood could contain antibodies that are common in celiac disease. So don’t stop eating pasta and bread just yet – any antibodies your body might produce won’t be present in your blood if you eat gluten-free.

Intestinal biopsy: If your blood tests suggest celiac disease, your health care provider could use an endoscope to remove a tiny piece of tissue from your small intestine. The procedure will show if there’s damage to the villi, tiny hair-like projections that help the small intestine absorb nutrients.

Skin biopsy: This is another method to check for the presence of antibodies in celiac disease. If a skin biopsy and blood tests both suggest celiac disease, there may be no need for an intestinal biopsy.

Genetic tests: If blood tests and a biopsydon’t provide a clear diagnosis, your provider may want to do a genetic test that looks at your blood for a variant of the human leukocyte antigen (HLA) gene. This gene alone can’t confirm that you have celiac disease, but the test can be used in combination with others to make an accurate diagnosis.

Facts and myths

You can find out more about celiac disease at the Celiac Disease Foundation website. The foundation’s Fast Facts page answers common questions, including:

Are people with celiac disease always skinny? (No)

Is my child's school required to provide a gluten free lunch? (Yes)

Will glutenase and other "gluten cutter" products help those with celiac disease digest gluten? (No)

If you suspect that you may have celiac disease, talk to your health care provider about a full evaluation. You can find a Providence provider find a Providence provider here.

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