Celiac Disease

Celiac disease is a genetic (inherited) digestive disorder of the small intestine manifested by interference with absorption of nutrients from food. Other names for celiac disease are sprue, nontropical sprue, and celiac sprue. Individuals who have celiac disease cannot tolerate a protein called gluten, which is present in wheat, rye, and barley. When people with celiac disease eat foods containing gluten, their immune system reacts, resulting in damage to the lining of the small intestine. Celiac disease can be diagnosed with blood tests and by examining a small piece of the intestine from a biopsy.

The May 18, 2005, issue of JAMA includes an article reporting that infants who had initial exposure to foods containing wheat, barley, or rye either in the first 3 months of life or after 6 months were at increased risk for celiac disease. This Patient Page is adapted from one originally published in the March 20, 2002, issue of JAMA.

Celiac disease symptoms may start in childhood or adulthood, with onset and severity influenced by the amount of gluten that is eaten.

Symptoms include

• Stomach pain, gas, and bloating

• Chronic diarrhea

• Pale, foul-smelling bowel movements

• Weight loss

• Bone or joint pain

• Dermatitis herpetiformis, a painful rash of itchy blisters

• Stunted growth (in children)

There is no specific medicine or surgery to treat celiac disease. The only cure is strict and complete avoidance of gluten. Following a gluten-free diet is a lifetime requirement for individuals with celiac disease. A gluten-free diet will stop symptoms and allow for healing of the intestinal damage. Gluten-free flour, bread, pasta, and other products are available.

Recommended Gluten-Free Foods

Breads or baked goods prepared from corn, potato, rice, or soy flours or from cornmeal

Cereals prepared from soy, corn (hominy), rice, cornmeal, or quinoa

Noodles and pasta prepared from rice or other allowed ingredients

All meats, chicken, and fish

Milk and unprocessed cheese

Dried beans, nuts, and peanut butter

Corn and rice

Unprocessed fruits and vegetables

Gluten-Containing Foods to Avoid

Breads or baked goods prepared from wheat, barley, or rye

Cereals made from wheat, rye, or barley

Pasta prepared from wheat, rye, barley, or semolina

Creamed or breaded vegetables

Salad dressings, gravies, sauces, and soups prepared with gluten-containing ingredients

• Celiac Disease Foundation
  818/990-2354
  http://www.celiac.org

• Celiac Sprue Association
  877/272-4272
  http://www.csaceliacs.org

• National Institute of Diabetes and
  Digestive and Kidney Diseases
  301/654-3810
  http://www.niddk.nih.gov

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on nutrition was published in the April 26, 2000, issue.

Sources: American College of Gastroenterology,American Gastroenterological Association, Celiac Disease Foundation, Celiac Sprue Association, Mayo Clinic, National Institute of Diabetes and Digestive and Kidney Diseases

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

TOPIC: DIGESTIVE DISORDERS