Celiac disease is a chronic autoimmune disorder in which eating gluten (a protein of wheat, rye and barley) causes damage to the lining of the small intestine. The villi responsible for absorption become flattened, and nutrients are absorbed poorly.
Often celiac disease first shows up not as a change in stool but precisely as treatment-resistant iron-deficiency anemia.
What celiac disease is
In celiac disease the immune system reacts to gluten and damages the person's own gut. Symptoms vary: bloating, diarrhea or constipation, abdominal pain, but also fatigue, weight loss, skin rashes (dermatitis herpetiformis), joint pain. In some people intestinal complaints are minimal — these are 'silent' forms.
Why anemia occurs
Iron, folate and vitamin B12 are absorbed mainly in the initial parts of the small intestine — exactly where celiac disease damages the lining. So iron absorption is impaired, and a deficiency with subsequent anemia develops. Persistent iron-deficiency anemia without obvious blood loss is a reason to be tested for celiac disease.
Diagnosis and treatment
The workup begins with blood tests for antibodies (primarily to tissue transglutaminase, tTG-IgA); with a positive result the diagnosis is confirmed by a small-intestine biopsy during endoscopy. Important: the tests are done while eating a normal diet with gluten. The only treatment is a lifelong strict gluten-free diet; on it the lining heals, and the anemia usually resolves.
Calculate using this marker
Calculators where Celiac disease is used directly:
Frequently asked questions
Can celiac disease occur without stomach problems?
Yes. In some people intestinal symptoms are minimal, and the disease shows up as fatigue, iron-deficiency anemia, osteoporosis or a skin rash. That is why stubborn anemia is sometimes investigated for celiac disease.
Do you need to eat gluten before a celiac test?
Yes. Antibodies and biopsy are only informative while eating a diet with gluten. If you switch to a gluten-free diet beforehand, the results may come out falsely negative — discuss the approach with your doctor.