Q: Every time I eat bread or pasta, I feel miserable. Does this mean I have celiac disease?
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A: It’s a common question, and the answer is not always yes.
Both celiac disease and gluten sensitivity may cause gastrointestinal symptoms after the ingestion of gluten. This may include bloating, abdominal pain, fatigue and diarrhea. It is important to see a gastroenterologist to differentiate between the two conditions.
Gluten is a protein found in wheat, barley and rye. Celiac disease is an autoimmune condition by which repeated ingestion of gluten leads to damage of the lining of the small intestine. This often leads to malabsorption of various vitamins and nutrients, which can contribute to anemia, weight loss and decreased bone mineral density. Celiac disease is diagnosed with simple blood tests as well as an upper endoscopy with biopsies of the small intestine. It is important the patient continue to ingest gluten leading up to these tests as they may no longer be accurate if the patient has already transitioned to a strict gluten-free diet. If celiac disease is confirmed, the patient will need adhere to a lifelong gluten-free diet and be regularly monitored by their gastroenterologist.
Gluten sensitivity differs from celiac disease as it is not an autoimmune condition (i.e., damage to the small intestine does not occur). Gluten is a known high FODMAP food. FODMAPS are types of sugars and sugar alcohols that are not easily digested in the small intestine and become fermented by gut bacteria in the colon. This fermentation process can lead to bloating, abdominal pain and diarrhea. This can be treated with avoidance of gluten-containing foods as well as other medications and supplements at the direction of a gastroenterologist but does not require lifelong monitoring like celiac disease.
If the ingestion of gluten often results in gastrointestinal symptoms and regret, schedule an appointment with your doctor to discuss undergoing evaluation for celiac disease so a treatment plan may be formulated for you.
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Dr. Joseph Moore is a gastroenterologist with Galen Digestive Health and a member of the Chattanooga-Hamilton County Medical Society.