Celiac disease

What is celiac disease?

Celiac disease is an autoimmune condition where the immune system misidentifies gluten as a threat and triggers an inflammatory reaction in the small intestine. In genetically predisposed individuals, this response damages the villi — the tiny finger-like projections that line the intestinal wall and absorb nutrients. As villi flatten and disappear, the intestine's absorptive capacity is progressively lost.

The consequence is malabsorption as the body fails to adequately absorb iron, B12, folate, vitamin D, calcium, magnesium, and other essential nutrients, regardless of dietary intake. This produces wide-ranging effects across multiple body systems, not just digestion.

Celiac disease is distinct from gluten sensitivity (non-coeliac gluten sensitivity), which involves digestive discomfort without the autoimmune intestinal damage, and from wheat allergy, which involves a different immune mechanism.

Common symptoms of celiac disease

Celiac disease symptoms are highly variable, ranging from classic gastrointestinal presentation to entirely non-digestive symptoms, and in many cases no obvious symptoms at all. Common signs include:

• Bloating or stomach swelling

• Gas or flatulence after meals

• Diarrhoea or constipation

• Abdominal discomfort or cramping

• Unexplained tiredness or fatigue

• Iron-deficiency anaemia (feeling cold, pale, or weak)

• Unintended weight loss or difficulty maintaining weight

• Bone or joint pain (from low calcium or vitamin D)

• Peripheral neuropathy (tingling or numbness in hands and feet, from B12 deficiency)

• Skin issues (such as a persistent rash)

• Mouth ulcers and dental enamel defects

• Mood changes, brain fog, or mild cognitive difficulties

• In children: failure to thrive, delayed growth, and behavioural changes

The "silent" form, where intestinal damage is present but symptoms are minimal, is particularly common in adults and is why screening based on symptoms alone misses a large proportion of cases.

What causes celiac disease?

Celiac disease requires both genetic predisposition and gluten exposure to develop. Contributing factors include:

• Genetic predisposition: Most people with celiac disease carry HLA-DQ2 or HLA-DQ8 gene variants.

• Autoimmune reaction: The immune system attacks intestinal tissue after gluten exposure.

• Environmental triggers: infections, significant dietary changes, pregnancy, surgery, or major physiological stress can precipitate onset in predisposed individuals.

• Family history: first-degree relatives of people with celiac disease have a 10–15% lifetime risk of developing the condition.

• Other autoimmune conditions: type 1 diabetes, thyroid disease, and Down syndrome are associated with significantly higher celiac disease prevalence.

How is celiac disease detected?

Celiac disease is identified via blood tests for autoimmune markers and nutrient levels. While a gastroenterologist’s biopsy is required for confirmation, blood screening is the essential first step.

Blood tests: Elfcare's panel includes the primary celiac screening markers and the key nutritional markers reflecting malabsorption:

• tTG-IgA: The primary screening marker for active celiac disease.

• Total IgA: Measured to ensure tTG-IgA results are accurate and not a false negative.

• EMA & DGP: Specific confirmatory markers used to refine the diagnosis.

• Hemoglobin, ferritin, & iron: Detects iron-deficiency anemia, a common sign of malabsorption.

• Vitamin B12 & folate: Essential for nerve health; levels are often low due to gut damage.

• Vitamin D & calcium: Monitored to prevent bone loss and mineral depletion.

• Magnesium: Often low in active disease due to impaired intestinal absorption.

• TSH: Screens for thyroid disease, which frequently co-occurs with celiac disease.

Abdominal MRI: while blood tests are the primary tool, an abdominal MRI can identify structural complications, such as bowel wall changes or lymphadenopathy, providing a comprehensive view of internal organ health.

Why early detection matters

Celiac disease often develops silently, with an average diagnosis taking 6–10 years. During this decade of delay, intestinal damage accumulates and nutrient deficiencies compound. Early detection through blood testing allows for a gluten-free diet that can fully reverse gut damage and prevent long-term risks like osteoporosis, neuropathy, and lymphoma.

By identifying autoimmune and absorption biomarkers early, you can address subtle imbalances before they impact your energy, mood, and immunity. Rather than reacting to established damage, early insight empowers you to restore gut health and maintain long-term metabolic balance.

Long-term complications of untreated celiac disease

Untreated celiac disease causes progressive intestinal damage and sustained nutrient malabsorption. Over time, this can result in serious complications:

• Osteoporosis: from chronic calcium and vitamin D malabsorption

• Anaemia: from iron, B12, or folate deficiency

• Peripheral neuropathy: from B12 deficiency and direct immune-mediated nerve damage

• Infertility and pregnancy complications: in both men and women

• Systemic risks: Higher susceptibility to other autoimmune conditions and rare intestinal lymphomas.

Strict adherence to a gluten-free diet is essential, as it typically reverses intestinal damage and significantly reduces these long-term risks.

How Elfcare can help

Elfcare's blood panel includes tTG-IgA and total IgA, the primary celiac screening markers, alongside a comprehensive nutritional profile covering iron, B12, folate, vitamin D, calcium, and magnesium. Together these provide both the direct autoimmune signal and a picture of its downstream nutritional consequences.

Our abdominal MRI adds structural context, and our AMRA® body composition analysis can identify low muscle mass and nutritional depletion patterns associated with chronic malabsorption.

If our blood tests identify elevated celiac antibodies or significant nutritional deficiencies consistent with malabsorption, we take care of further diagnostics or refer you to the appropriate specialist — typically a gastroenterologist for confirmatory biopsy and dietary management.