A gluten-free diet is the treatment for all wheat-related disorders. These disorders include celiac disease, non-celiac gluten sensitivity, and wheat allergy. It is important that you see a provider trained to differentiate these conditions as they mean very different things for your overall health.
Blood tests are an important part of making a diagnosis of celiac disease, but cannot be used alone to diagnose celiac disease. Blood tests for celiac disease detect antibodies (proteins in the blood that usually help the body fight off disease) that are markers of celiac disease. Blood tests are also available to see if people have the genetic background necessary to have celiac disease.
Providers at UCLA take into consideration the patient's symptoms, antibody levels, genetic markers, response to a gluten-free diet and small intestinal biopsy results when evaluating a patient for celiac disease. Most of the time, patients will require an upper endoscopy and small intestinal biopsy to make a diagnosis of celiac disease.
While some patients with celiac disease have typical symptoms such as bloating, cramping and diarrhea after eating gluten, many patients have what is called silent celiac disease. Patients with silent celiac disease have abnormal blood tests and evidence of inflammation in their small intestinal biopsies but do not overt gastrointestinal symptoms. These patients may have iron deficiency anemia, osteoporosis, abnormal liver tests, thyroid disorders, rash or even neurological disorders. For this reason, it is important for patients with the above conditions to be tested for celiac disease.
Working wih a skilled dietitian is an essential part of managing celiac disease. A dietitian with expertise in celiac disease will work closely with you to make sure that you are truly on a gluten-free diet. This is very important because even a small amount of gluten can cause inflammation in the small intestine. A dietitian can teach you how to read labels to uncover "hidden" sources of gluten and provide recipes, shopping lists and tips for eating in restaurants. It is recommended that patients with newly diagnosed celiac disease meet with a trained dietician at least once.
We recommend that patients with celiac disease aim to be completely gluten free. Even small amounts of gluten have been shown to cause intestinal damage in patients with celiac disease. Because it is often difficult to measure how much gluten is contained in a single product, it is safest to be completely gluten free.
If you initially responded to a gluten-free diet, but your symptoms come back it may be because of inadvertent gluten intake. However, it is important to know that there are several other gastrointestinal conditions that are more common in patients with celiac disease. Examples include small intestinal bacterial overgrowth, specific sugar malabsorption and microscopic colitis. It is important to see a provider to determine if new symptoms are due to celiac disease or something else.