

Avoiding gluten has become something of a health fad in recent years, but certain proteins found in wheat, barley and rye (commonly described in the aggregate as “gluten”) can also trigger a serious autoimmune reaction in the lining of the small intestine, reducing the body’s ability to absorb nutrients.

This genetically linked condition, known as celiac disease, is believed to affect roughly 1 percent of the population, though the vast majority of people impacted (as much as 85 percent) don’t realize they have it.

We asked Dr. Sheila Crowe, director of the Celiac Disease Clinic at UC San Diego Health System and Dr. Martin Kagnoff, professor emeritus of medicine and pediatrics in the UC San Diego School of Medicine and a national authority on celiac disease, for a status report.

Q: How serious is celiac disease if it has no obvious symptoms in most people?

A: There is a wide range of symptoms and clinical presentations associated with celiac disease. Some individuals with celiac disease have no obvious digestive complaints, but may have mild iron deficiency, a premature decrease in bone density or infertility. Some may have severe digestive problems with abdominal pain, weight loss and chronic diarrhea. The most common complaints associated with celiac disease include abdominal discomfort, abdominal bloating, flatus (gas), loose stools and fatigue. It is not understood why there are such differences among patients who may have the same degree of celiac-disease-related damage to their intestines.

Q: Are there any theories about why more people with celiac disease have atypical or more silent symptoms today than two decades ago?

A: It is believed that celiac disease was not identified, except in the more severe cases, until relatively recently. Less severe cases were not recognized as being celiac disease and thus did not undergo testing for this condition. The development of better blood tests to screen for celiac disease has been instrumental in leading to an increase in the diagnosis of celiac disease.

An additional factor is that the frequency of celiac disease in the U.S. population has increased roughly five-fold in the last 50 years. This, combined with better ways to detect early or less severe disease, has given rise to a relative increase of non-classical or atypical forms of the disease. Silent celiac disease (no symptoms despite an abnormal intestinal biopsy and elevated antibodies indicating gluten sensitivity) is usually detected through screening.

Q: Given the disease’s elusiveness, who should be screened? Why not screen everyone?

A: At present, there are no universal guidelines to screen everyone for celiac disease. This is largely due to the lack of studies that would prove that the cost of screening and confirming the diagnosis of celiac disease and its treatment is worthwhile or cost-effective. Instead, targeted screening is recommended. For example, the American College of Physicians and other national medical societies recommend screening for celiac disease in various settings, including first- and second-degree relatives of an individual with celiac disease as confirmed by intestinal biopsy, certain unexplained neurological conditions, certain patients with Type I diabetes mellitus and autoimmune thyroid disease, among others.


