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Celiac Disease

Celiac Disease Explained

Celiac disease occurs when the immune system reacts abnormally to gluten, causing inflammation and injury to the lining of the small intestine. Over time, this damage flattens the villi—tiny projections that absorb nutrients—leading to malabsorption, nutrient deficiencies, and a wide range of digestive and non-digestive symptoms.

The condition is genetic and lifelong, but symptoms often improve and the intestine can heal when gluten is strictly removed from the diet. A strict gluten-free diet is currently the only proven treatment.

Symptoms

Celiac disease can cause classic digestive symptoms like diarrhea and bloating, but many people present with fatigue, anemia, bone loss, or other subtle signs. Some individuals have few or no symptoms despite intestinal damage.

Symptoms include:
Chronic diarrhea, constipation, or alternating bowel habits
Bloating, gas, and abdominal pain
Unexplained weight loss or poor weight gain
Fatigue, weakness, iron-deficiency anemia
Pale, foul-smelling, or bulky stools
Bone or joint pain, osteoporosis, mouth sores, or skin rash (dermatitis herpetiformis)

When to call

Call the office if you have persistent diarrhea, bloating, weight loss, anemia, or other symptoms suggestive of celiac disease, especially with a family history or other autoimmune conditions. Also call if you have diagnosed celiac disease but symptoms or labs are not improving on a gluten-free diet.

Seek emergency care for signs of severe dehydration (such as dizziness, confusion, or feeling faint), severe abdominal pain, or black/bloody stools. Although many celiac symptoms are chronic rather than emergency-type, these signs may indicate a different or more serious problem that needs immediate evaluation.

Evaluation & Tests
Management & Treatment

Evaluation involves blood tests for specific celiac antibodies and, if positive or strongly suspected, upper endoscopy with small-bowel biopsies to confirm the diagnosis. Testing is usually done while the patient is still eating gluten regularly.

History of symptoms, family history of celiac disease, and associated autoimmune conditions
Serologic testing for celiac-associated antibodies (e.g., tissue transglutaminase IgA, total IgA)
Upper endoscopy with multiple duodenal biopsies to assess for villous atrophy and confirm diagnosis
When needed, genetic testing (HLA-DQ2/DQ8) to help rule out celiac disease in unclear situations
Evaluation for nutritional deficiencies (iron, B12, folate, vitamin D, calcium)

The cornerstone of treatment is a lifelong strict gluten-free diet, often with guidance from a dietitian. Management also includes correcting nutrient deficiencies, monitoring symptom and antibody response, and screening for complications.

Lifelong strict avoidance of gluten-containing grains (wheat, barley, rye) and cross-contamination
Dietitian support to ensure a balanced gluten-free diet and label reading skills
Replacement of deficient nutrients (iron, calcium, vitamin D, B vitamins, etc.)
Periodic monitoring of symptoms and celiac antibody levels; repeat endoscopy in selected cases
Screening and management of associated conditions such as osteoporosis or other autoimmune diseases
This information is for general educational purposes only and is not a diagnosis or personalized medical advice. It does not replace a visit with your own healthcare provider. Always follow the specific recommendations given by your medical team. If you have urgent or worsening symptoms, contact your provider or seek emergency care right away.

At-a-glance

Abdominal painBloating / gasDiarrheaWeight loss / anemia

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Information on this website is for education only and not a substitute for medical advice.

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