Celiac disease is an autoimmune condition in which the body’s immune system reacts to gluten, a protein found in wheat, barley, and rye. This reaction damages the lining of the small intestine and can interfere with nutrient absorption. While many people associate celiac disease with digestive symptoms, the condition can affect many parts of the body and sometimes presents in subtle ways. Knowing when to get tested and how gastroenterology specialists evaluate celiac disease can help you find answers and begin appropriate care.
What Is Celiac Disease?
Celiac disease triggers an immune response to gluten that damages tiny, finger-like projections called villi that line the small intestine. Healthy villi help absorb nutrients from food. When they are damaged, your body may not get the vitamins, minerals, and calories it needs, which can lead to malnutrition and a range of symptoms. Celiac disease is a lifelong condition that requires strict adherence to a gluten-free diet.
Who Should Be Tested?
Testing for celiac disease may be recommended for people with certain symptoms or risk factors. Common symptoms include:
- Chronic diarrhea or constipation
- Bloating, gas, or abdominal pain
- Unintended weight loss
- Fatigue or anemia
- Nutrient deficiencies (such as iron or vitamin D)
However, not everyone with celiac disease has obvious digestive complaints. Symptoms can also include:
- Headaches or foggy thinking
- Joint pain
- Skin rash known as dermatitis herpetiformis
- Delayed growth in children
- Infertility or recurrent miscarriage
Testing is also recommended for people with a first-degree relative (parent, sibling, or child) with celiac disease, as genetics play a role. Other conditions associated with an increased risk of celiac disease include type 1 diabetes and autoimmune thyroid disease.
How Is Celiac Disease Tested?
Testing usually begins with blood tests that look for specific antibodies associated with celiac disease. The most commonly used blood test is the tissue transglutaminase antibody (tTG-IgA) test. These antibodies tend to be elevated in people whose immune system is reacting to gluten. It is important that you continue to eat gluten before and during testing; removing gluten too early can lead to false-negative results.
If blood tests suggest celiac disease, gastroenterologists typically recommend an upper endoscopy with small intestinal biopsy. During this procedure, a thin, flexible tube with a camera (endoscope) is passed through your mouth into the small intestine. Small samples of tissue are taken to look for damage to the villi under the microscope. This confirms the diagnosis and helps the doctor understand the extent of intestinal injury.
What to Expect from a GI Evaluation
A gastroenterology (GI) provider will start with a detailed medical history and physical exam. They will ask about your symptoms, family history, and any other medical conditions. If testing is indicated, blood work may be ordered first, followed by imaging or endoscopic evaluation.
Upper endoscopy is generally performed on an outpatient basis with sedation to ensure comfort. You will be instructed to fast for a certain period before the procedure. During the exam, multiple biopsies may be collected to maximize the accuracy of diagnosis. The biopsy results may take a few days to return.
Gastroenterologists will also assess for other conditions that can mimic or accompany celiac disease, such as lactose intolerance, small intestinal bacterial overgrowth (SIBO), or inflammatory bowel disease. Since symptoms may overlap with other digestive disorders, a comprehensive evaluation helps ensure the correct diagnosis and treatment plan.
Living with Celiac Disease
Once diagnosed, the cornerstone of treatment for celiac disease is a strict gluten-free diet. This means avoiding all foods and products that contain wheat, barley, rye, and any derivatives of these grains. Even small amounts of gluten can cause symptoms and intestinal damage. Over time, many people experience significant improvement in symptoms and intestinal healing when gluten is completely removed from the diet.
Working with a registered dietitian who is knowledgeable about celiac disease can make managing a gluten-free diet easier and more balanced. Label reading, cross-contamination prevention, and eating out safely are all important skills that can improve quality of life.
Why Early Detection Matters
Early diagnosis and treatment of celiac disease help prevent complications such as anemia, osteoporosis, infertility, neurological issues, and increased risk of other autoimmune conditions. If untreated, ongoing intestinal damage can lead to long-term health consequences.
When to Talk to a GI Provider
If you suspect celiac disease based on symptoms or family history, talk to your primary care provider or a GI Alliance gastroenterology specialist. These providers are highly trained in digestive health diagnosis and management and can recommend the appropriate tests and follow-up care.
To learn more about celiac disease and find a GI Alliance physician near you, find a provider now.
