GI Conditions
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      1. VCT Resource Library
      2. GI Conditions

      Celiac Disease

      Condition: Celiac Disease

      Brief Overview: Celiac Disease is an autoimmune condition. With Celiac Disease, when gluten is ingested, the body develops an immune response that attacks and damages the small intestine.

      Prevalence: According to UpToDate, “The estimated global prevalence of celiac disease based on serologic studies is approximately 1 percent.”

      Etiology: Typically, celiac disease has a genetic predisposition. Environmental factors are also thought to cause Celiac Disease. It is triggered by consuming gluten.

      Risk Factors:

      • Family history of Celiac disease in first- and second-degree relatives
      • Type 1 Diabetes
      • Autoimmune thyroiditis
      • Down and Turner Syndromes
      • Pulmonary hemosiderosis
      • Several other autoimmune diseases also increase risk for Celiac Disease

      Commonly Associated Conditions:

      • Selective IgA deficiency
      • Iron deficiency anemia
      • Osteoporosis
      • Type 1 Diabetes
      • Autoimmune thyroid disease, Hypothyroidism
      • Atopic dermatitis
      • GERD
      • Eosinophilic esophagitis
      • IBD – more frequently with ulcerative colitis than Crohn’s
      • Liver disease
      • Idiopathic pulmonary hemosiderosis
      • Cardiovascular disease – autoimmune myocarditis, idiopathic dilated cardiomyopathy
      • Kidney disease – Glomerular IgA deposition
      • Hyposplenism

      Common Medications:

      • There is no medication for Celiac Disease. The treatment is to stop consuming gluten.
      • Corticosteroids may be used if there is severe inflammation that does not response to the gluten-free diet
      • Nutritional supplementation may be needed (like iron, Vitamin B12, Vitamin D, etc.)
      • Medications for symptoms, like diarrhea, or rash

      Common Labs, Imaging, and Tests:

      • Serologic testing – tTG-IgA and total IgA, EMA-IgA
      • Upper endoscopy with small bowel biopsy
      • Vitamins A, D, E, B12, folic acid, ferritin, iron, prothrombin time. May also test for deficiencies in thiamine, B6, magnesium, copper, zinc, selenium

      Common Symptoms:

      • Some people are asymptomatic
      • Abdominal pain
      • Diarrhea
      • Oily bowel movements that float
      • Weight loss
      • Bloated
      • Feeling full constantly
      • Poor appetite
      • Gas
      • Pruritic rash
      • Fatigue

      Common Treatments:

      • Gluten-free diet
      • Management of any nutritional deficiencies

      Physical Findings:

      • Abdominal tenderness, distention
      • Weight loss
      • Anemia
      • Dermatitis herpetiformis
      • Atrophic glossitis (oral lesions)

      Potential Complications and Contraindications:

      • Constipation
      • Increased risk for lymphoma and GI cancer
      • Increased risk of microscopic colitis
      • Increased risk of pancreatitis
      • Nonresponsive celiac disease despite following a gluten-free diet
      • Refractory celiac disease
      • Ulcerative jejunitis
      • Skin conditions – dermatitis herpetiformis is the skin condition most commonly associated with celiac disease (this is itchy and burns, usually located in the lower back, buttocks, face, neck, trunk, knees, elbows)
      • Osteopenia
      • Medication absorption may be impacted

      General Health and Lifestyle Guidance:

      • A DEXA scan may be recommended 12 months after starting a gluten-free diet
      • Calcium and vitamin D supplements may be recommended by your healthcare provider
      • Read food and medication labels carefully

      Suggested Questions to Ask Patients:

      • Have you been diagnosed with celiac disease or have a family history of it?
      • Do you currently follow a gluten-free diet?
      • Have you experienced persistent GI symptoms, fatigue, or nutrient deficiencies?
      • Have you ever been tested for celiac antibodies or had a biopsy?
      • Are you working with a dietitian for meal planning?

      Potential Questions to Ask if Patient Reports A Symptom 

      • How long has this been going on? Or, when did this start? 
      • Is it constant, or does it come and go? 
      • How would you rate the severity? Mild, moderate, or severe? 
      • Can you describe the symptom? 
      • How often does this happen? Multiple times per day, daily, weekly, occasionally, etc.  
      • How long does each episode last? 
      • Is it getting better, worse, or staying the same? 
      • What seems to make it better, worse? 
      • Have you tried anything that helps the symptom? 
      • Have you noticed anything specific that brings the symptom on? 
      • Does it interfere with your daily life, activities? 
      • Have you noticed any other symptoms that happen at the same time? 
      • Have you ever experienced this before in the past? 
      • Any recent changes in medications, lifestyle, diet, etc.? 
      • Have you reported this to your healthcare provider yet?  
        • If the answer is yes – what did your healthcare provider say? 
        • If the answer is no – advise to call to report this to healthcare provider 

      Suggested Talking Points:

      • Work with your dietician to make sure you’re correctly following a gluten-free diet
      • Discuss the pneumonia vaccine with your healthcare provider
      • If you experience constipation, talk with your healthcare provider about fiber supplementation
      • Some people may need to use separate cooking utensils, toasters, microwaves, etc. from others living in the house to avoid cross-contamination with gluten-containing products

      Other Helpful Tips for Coordinators to Share

      • Emphasize the need for strict gluten avoidance → even small amounts can cause intestinal damage.
      • Encourage kitchen safety practices: use separate toaster, cutting boards, condiments to avoid cross-contamination.
      • Remind patients to check medication and supplement labels for gluten-containing fillers. Can also check with pharmacist for help.
      • Reinforce the importance of follow-up care: blood tests for nutritional deficiencies (iron, vitamin D, B12) and bone health checks.

      Common Trigger Foods for Celiac Disease (contain gluten)

      (must be avoided in all forms)

      • Wheat (all varieties: whole wheat, white flour, durum, semolina, spelt, farro, einkorn, graham, bulgur, couscous)
      • Barley (malt, malt vinegar, beer unless gluten-free)
      • Rye (bread, crackers, cereals containing rye)
      • Triticale (hybrid of wheat and rye)
      • Regular pasta, noodles, pizza crust, bread
      • Cakes, cookies, pastries made with wheat flour
      • Gravies, sauces, and soups thickened with wheat flour
      • Soy sauce (unless labeled gluten-free)
      • Processed meats with fillers (hot dogs, sausages, deli meats unless certified GF)
      • Snack foods like pretzels, crackers, chips with wheat-based flavorings

      ⚠️ Hidden sources: salad dressings, candy, seasoning packets, oats not labeled gluten-free (cross-contamination).

      Naturally Gluten-Free Foods

      • Grains & Starches (safe alternatives)
        • Rice (white, brown, wild, jasmine, basmati)
        • Quinoa
        • Buckwheat
        • Millet
        • Amaranth
        • Teff
        • Corn (cornmeal, polenta, popcorn)
        • Certified gluten-free oats
        • Cassava (yuca)
        • Potato (white, red, sweet, yams)
        • Arrowroot
        • Tapioca
      • Proteins
        • Fresh meat (beef, pork, lamb, poultry)
        • Fresh fish and seafood
        • Eggs
        • Legumes (beans, lentils, chickpeas, peas)
        • Nuts and seeds
        • (⚠️ Avoid processed or breaded versions unless labeled GF.)
      • Dairy (plain, unprocessed)
        • Milk
        • Butter
        • Most cheeses
        • Yogurt (plain, unsweetened — flavored varieties may contain additives)
        • Cream and cream cheese
      • Fruits & Vegetables
        • All fresh fruits (apples, bananas, berries, citrus, melons, grapes, etc.)
        • All fresh vegetables (leafy greens, carrots, broccoli, peppers, squash, etc.)
      • Fats & Oils
        • Olive oil
        • Coconut oil
        • Avocado oil
        • Vegetable oils (canola, sunflower, safflower, corn oil)
      • Beverages
        • Water
        • 100% fruit juice
        • Coffee (plain, unflavored)
        • Tea (plain black, green, or herbal — watch for additives)
      • ⚠️ Cross-Contamination Reminder: Even naturally gluten-free foods can become unsafe if:
        • Cooked in the same oil as breaded items
        • Cut on the same board as wheat bread
        • Processed in a facility that handles wheat without gluten-free certification

      Common Gluten-Free Brands

      (these are widely available in the U.S. — helpful for patients just starting out)

      • Breads, Baking & Pantry Staples
        • Udi’s – breads, bagels, muffins, pizza crusts
        • Canyon Bakehouse – breads, buns, bagels, English muffins
        • Schar – crackers, bread, rolls, cookies, snacks
        • King Arthur – certified GF flours and baking mixes
        • Bob’s Red Mill – GF oats, flours, pancake mixes
      • Snacks & Packaged Foods
        • Glutino – pretzels, crackers, cookies
        • Enjoy Life – cookies, snacks, allergen-free chocolate
        • Made Good – snack bars, granola, bites
        • Simple Mills – crackers, baking mixes
      • Frozen & Convenience Foods
        • Against the Grain – pizzas, breads
        • Amy’s Kitchen – GF frozen entrees and soups
        • Caulipower – GF pizza crusts
      • Pasta
        • Barilla Gluten Free – pasta (made from corn & rice)
        • Tinkyada – rice pasta
        • Banza – chickpea pasta

      10 SMART Goal Examples for Patients with Celiac Disease

      1. “I will read the ingredient labels on 3 packaged foods each time I grocery shop for the next 4 weeks.”
      2. “I will replace regular bread with a certified gluten-free bread starting this week.”
      3. “I will prepare 1 gluten-free dinner recipe at home each week for the next month.”
      4. “I will download and use a gluten-free scanner app on my phone before trying new foods for the next 2 weeks.” (Some options to check out: Gluten-Free Scanner, ShopWell, Fig (Food Is Good), Sift)
      5. “I will join one celiac support group online within the next month.”
      6. “I will keep a food and symptom diary daily for 4 weeks to identify possible cross-contamination.”
      7. “I will ask about gluten-free options when dining out at least once per week.”
      8. “I will switch my household condiments (butter, peanut butter, jam) to separate gluten-free containers this week.”
      9. “I will try one new certified gluten-free brand or product each week for the next 4 weeks.”
      10. “I will schedule a follow-up with my dietitian within the next 2 months to review my diet.”

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.