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Patient Education

Celiac Disease

What Is Celiac Disease?

Celiac disease is a digestive condition that causes an adverse immune response to eating gluten. Gluten is a protein found in wheat, rye, barley, and oats.

Gastroenterology Consultants of San Antonio - Celiac Disease
Normal small bowel lining covered by villi which are destroyed by inflammation in celiac disease

When someone with celiac disease eats gluten, it triggers an immune response in the small intestine.  This damages the lining of the small intestine over time. Eventually, it can prevent the absorption of some nutrients (malabsorption).  In addition to malabsorption, the damage can also cause weight loss, fatigue, diarrhea, anemia, bloating, or more serious complications.

There is no cure for Celiac disease, which is also called celiac sprue or gluten-sensitive enteropathy, but most people can manage symptoms and promote healing by adopting a gluten-free diet.

Celiac Disease Symptoms

Symptoms of Celiac Disease vary greatly and may include signs seemingly unrelated to the digestive system.  The most common symptoms are fatigue, weight loss, and diarrhea.

Digestive Symptoms

Non-Digestive Symptoms

Many adults will also experience symptoms of unrelated to the digestive system like:

  • Low vitamin levels, especially iron.
  • Osteoporosis or low bone density
  • Skin rash (dermatitis herpitiformis)
  • Bone and joint pain
  • Mouth ulcers
  • Stunted growth (in children)

Celiac Disease Rash

Some will develop a rash called dermatitis herpetiformis.  It is a very itchy rash with bumps and blisters. Dermatitis herpetiformis usually occurs on the knees, elbows, torso, buttocks, and scalp.

Roughly 10 percent of people with celiac disease will experience this rash.

Treatment for dermatitis herpetiformis usually involves medicines and adopting a gluten-free diet.

What Causes Celiac Disease?

Celiac Disease Symptoms and Treatment in San Antonio
Normal small bowel lining covered by villi which are destroyed by inflammation in celiac disease

Celiac disease is an autoimmune disorder.

An autoimmune disorder is a condition when your immune system attacks your body by mistake. A normally functioning immune system can sense harmful germs and sends antibodies to attack the problem.

In people with celiac disease, the immune system attacks the intestine when gluten is in it. This causes inflammation and damage to the villi. Villi are threadlike projections in the small intestine that absorb nutrients.  If damaged, the villi won’t absorb nutrients and the patient will become malnourished despite the amount of food they eat.

The exact cause of celiac disease is not known.

In some cases, celiac disease becomes active for the first time following pregnancy, childbirth, viral infection, surgery, or severe emotional stress.


Most people with bloating, diarrhea, or abdominal pain do not have celiac disease. If celiac disease is suspected, your doctor will first order blood tests.

Serologic tests – These tests look for antibodies in your blood. High levels of some antibodies could indicate an immune response to gluten.

Genetic tests – certain genetic tests can see if the genes responsible for celiac disease are present.

Blood tests can indicate a strong possibility of celiac disease, but an endoscopy with biopsy is recommended for a firm diagnosis.  In this procedure, a thin, flexible tube is used to inspect the small intestine and remove a small tissue sample (biopsy). The biopsy is reviewed for damage to the villi.

Eliminating gluten from your diet before testing is done could change the results of these tests.  It’s important to talk to your doctor about any changes in diet before testing begins.


Treatment for celiac disease involves removing all foods from gluten from your diet. Gluten is what triggers the reaction, resulting in damage to the small intestine. By removing gluten, the small intestine can heal and function normally.

People with celiac disease must stay on a gluten-free diet for the rest of their lives.  It may sound daunting, but many people adapt quite well over time.

Medications are only used in rare cases when a gluten-free diet isn’t effective in treating celiac disease.

Gluten-free diet:

The following grains contain Gluten and are NOT ALLOWED IN ANY FORM:Wheat, rye, barley, kamut, einkorn, spelt and triticale

Common foods that contain gluten include:

  • Cereals
  • Pastas
  • Baked Goods
  • Cakes
  • Pies
  • Cookies
  • Breads
  • Beer
  • Candies
  • Gravy
  • Salad Dressings
  • Ketchup
  • Mayonaise
  • Processed Cheese
  • Soy Sauce
  • Soups
  • Ice Cream
  • Oats

Frequently overlooked foods that often contain gluten:

  • Breading
  • Broth
  • Bulgar
  • Coating mixes
  • Communion wafers
  • Croutons
  • Couscous
  • Duram
  • Graham flour
  • Imitation bacon
  • Imitation seafood
  • Malt
  • Marinades
  • Processed meats
  • Sauces
  • Semolina
  • Stuffings

“Hidden” Gluten

If someone with celiac disease eats food with gluten, it may or may not cause a physical reaction.  That doesn’t mean it isn’t harmful. Even small amounts of gluten can be harmful and ‘hidden’ in some products like:

  • Modified food starch
  • Food preservatives
  • Vitamins/Supplements
  • Lipstick
  • Mouthwash and Toothpaste
  • Glue on envelopes and stamps
  • Medications – including prescription and over-the-counter medications.


ALLOWEDFoods that are acceptable to eat on a gluten-free diet include corn, rice, soy, potatoes, beans, sorghum, quinoa, millet, buckwheat, tef and nut flours

Adjusting to a gluten-free diet will take time.  An important part of adhering to a gluten-free diet is reading nutrition labels.  Your doctor may recommend visiting a dietitian who specializes in developing meal plans based on medical requirements.

Packaged foods should be avoided unless they say ‘gluten-free’ on the label or don’t contain ingredients with gluten.

People following a gluten-free diet can see symptom improvement in the first few weeks of the diet, often in the first few days. It could take years or months for the small intestine and villi to heal completely.


Is there a test for celiac disease?

If your doctor suspects celiac disease, they may recommend blood tests first.  If these tests show indications of the disease, an endoscopy may be performed to help confirm the diagnosis.  There is no single, definitive test for celiac disease.

Is there another treatment, besides a gluten-free diet?

No, there are no other treatments currently available.  On rare occasions, steroids or other medications may be used to suppress the immune system during severe attacks.

How long do I have to stay on a gluten-free diet?

Patients with celiac disease must stay on a gluten-free diet for the rest of their lives. It can be challengings to adjust to at first, but many adapt well over time.

What is gluten?

Gluten is a protein found in wheat, rye, barley, and other grains.  It can act as a glue that holds foods together. An example would be a pizza crust, which uses a high-gluten flour to create a chewy, durable bread that can hold up to sauce and toppings.  Some gluten-free pizza crust options are now available.

What is gluten-free?

Gluten-free is a designation for a diet or consumable product that does not contain gluten.  People with this disease should adopt a gluten-free diet and look for food products that have a gluten-free label.



“Dr. Ramirez has been my Gastro for many years. He was the doc that diagnosed me with Celiac. His office & himself are awesome! Communicates with any & all updates.” – Barbara


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