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Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Celiac Disease [Read/Print full article]
Overview
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Celiac disease, also known as celiac sprue, is an autoimmune disorder triggered by gluten. Gluten is a protein in grains such as wheat, barley, and rye. Many foods contain these grains, as do some common products such as lip balm, envelope glue, and Hasbro's Play-Doh.
An autoimmune disease occurs when the body's immune system, which normally fights infections and viruses, attacks its own cells.
If a person with celiac disease eats gluten, the immune system reacts by getting inflamed and destroying the villi (tiny fingerlike projections) that cover the surface area of the small intestine. Villi absorb nutrients from food. When the villi are damaged, the body cannot absorb vital nutrients. A person's symptoms depend on how severely the intestine is inflamed. The main treatment for celiac disease is to eliminate foods from the diet that contain wheat, rye, or barley.
About 3 million people in the United States have celiac disease. It affects people of all ages, from infancy to adulthood, and tends to run in families. Celiac disease is a permanent condition because the body is damaged by the immune system.
One difficulty for people with celiac disease is that a person can have it, but not have any symptoms. It can take about 4 years, on average, from the time you first experience symptoms to diagnosis. Unfortunately, this delay can cause damage to the small intestine and lead to long-term consequences, so talk us as soon as you have symptoms that concern you.
Celiac disease differs from food allergy, intolerance, or sensitivity
Some people confuse celiac disease with a food allergy (for example, to wheat) or food intolerance or sensitivity (for example, to gluten or dairy products) because these conditions also require a change in diet. However, food allergies occur when your immune system mistakes an ingredient in food as harmful and creates a defensive reaction to fight it off.
The most common foods that trigger allergic reactions are peanuts, tree nuts (walnuts, pecans, cashews, and almonds), fish, shellfish, milk, eggs, soy products, wheat, and sesame seeds. Food allergy symptoms can be mild (itching, rash, or hives) or more serious (shortness of breath or wheezing or chest pain) but differ from the symptoms of celiac disease. These symptoms include iron deficiency, gas and bloating, calcium malabsorption, early-onset osteopenia or osteoporosis (thinning or loss of bone density), and chronic diarrhea.
Food intolerance, the inability of the digestive system to digest certain foods, is far more common than food allergy. It is usually caused by an enzyme deficiency. Some common types of intolerance include lactose (milk), fructose (fruits, honey), gluten (wheat), and corn. Food intolerance or sensitivity symptoms can include nausea, cramps, diarrhea, and bloating, but this condition does not lead to nutritional deficiencies like celiac disease does.
Symptoms
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Most people with celiac disease do not experience symptoms if they eat only small amounts of gluten. They may feel well even though their intestines are damaged. However, some people are more sensitive and may react to even the smallest amount of gluten with such symptoms as:
- Gas and bloating
- Feeling tired and weak
- Stomach pain
- Constipation
- Stools that float or smell bad
- Migraine headaches
- Tingling in the hands and feet
- Canker sores in the mouth
- An itchy, long-lasting skin rash (dermatitis herpetiformis)
- Tooth discoloration or loss of enamel
Signs
One challenging aspect of celiac disease is that symptoms can vary greatly from person to person and depend on how much of the intestine is inflamed and damaged. In addition, there are signs of the disease that are not the same as its symptoms and usually indicate long-term damage to the intestines. Signs can include:
- Iron-deficiency anemia. The most common sign of celiac disease in adults is the presence of iron-deficiency anemia that does not respond to treatment.
- Calcium malabsorption. This can lead to early-onset osteopenia or osteoporosis (thinning or loss of bone density).
- Low levels of certain vitamins and minerals (iron, calcium, and folate).
- Chronic diarrhea (longer than 6 weeks). However, recent research has found that only one-third of adult patients diagnosed with celiac disease experience diarrhea.
- Bone or joint pain.
- Irritability or behavior change.
- Sudden or unexplained weight loss. This is uncommon but happens to some people.
Dermatitis Herpetiformis
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Dermatitis herpetiformis, also known as Duhring disease, is a very itchy skin rash that affects about 15 to 25 percent of people with celiac disease. A person might notice a strange-looking rash on the elbows, knees, and buttocks.
If you have celiac disease and experience this rash, it is likely that you will not experience digestive symptoms like gas, bloating, stomach pain, constipation, etc. We may refer you to dermatology for diagnosis and treatment.
Dermatitis herpetiformis is diagnosed by a skin biopsy, which involves removing a tiny piece of skin near the rash and testing it for antibodies. If you test positive, we will manage your condition with a gluten-free diet and medication to control the rash. Drug treatment is short-term, usually until the gluten-free diet starts to relieve symptoms.
Additional References:
- External Link to Dermatitis Herpetiformis (Duhring Disease)
- External Link to Iron Deficiency Anemia - Health Encyclopedia
Screening and Diagnosis
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Screening
Certain people are at higher risk of developing celiac disease. We may recommend regular celiac disease screening tests if you or your children have:
- A close relative (parent, sibling, or child) who has had a biopsy that confirms celiac disease
- A related autoimmune disorder such as insulin-dependent type 1 diabetes, Hashimoto's thyroiditis, Turner's syndrome, Williams syndrome, Graves disease, or Sjögren's disease
- Down syndrome
- Chronic diarrhea (longer than 6 weeks) or other gastrointestinal symptoms
- Low bone density
- Repeated miscarriages or infertility where a medical cause cannot be found
- Unexplained weight loss
- Short stature
- Unexplained failure to thrive in childhood
- Failure to gain weight or height in childhood
For people at higher risk of celiac disease, we recommend regular testing because a delayed diagnosis can cause long-term complications. We may recommend 2 kinds of tests:
Blood test. This is the most common and accurate test for diagnosing celiac disease. People with celiac disease who have eaten gluten have higher than normal levels of certain antibodies in their blood. The anti-tissue transglutaminase (tTG-IgA) screening test is used to look for antibodies in your blood. Antibodies are produced by the immune system in response to gluten proteins (found in wheat, rye, and barley).
Endoscopy exam. If the tTG-IgA screening test or your symptoms suggest celiac disease, an endoscopy exam will allow us to obtain a biopsy (tiny pieces of tissue) from the small intestine. We will examine the biopsy sample under a microscope and look for damaged villi, which indicate an inflammatory response in the intestines. Our Emmi video for Upper GI endoscopy is an excellent tool to help you prepare for this procedure. Look for it in the health tools section.
Preparing for medical tests
It is important to continue eating gluten until the tests have been performed and diagnosis has been established. Any changes in your diet, such as going on a gluten-free diet, can affect the accuracy of test results. It may be necessary for you to eat gluten every day for at least 4 weeks before the blood test or endoscopy. If you are scheduled for biopsy and are not eating gluten, talk to us about what is necessary to obtain accurate results.
Challenges of diagnosis
Celiac disease is challenging to diagnose because its symptoms are similar to many other gastrointestinal conditions including:
- Irritable bowel syndrome
- Iron-deficiency anemia
- Inflammatory bowel disease
- Diverticulitis
- Intestinal infections
- Chronic fatigue syndrome
We will use the best possible methods to determine the cause of your symptoms and to establish an accurate diagnosis.
Additional References:
- External Link to Chronic Fatigue Syndrome
Causes and Risk Factors
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We do not know the exact cause of celiac disease, but the greatest risk factor seems to be genetics. If your first-degree relatives (parents, children, and siblings) or second-degree relatives (grandparents, aunts, uncles, nieces, nephews, and half-siblings) have celiac disease, you have a higher chance of developing celiac disease compared to the general population.
We also know that if you have susceptibility due to your family history, the disease can be triggered by certain life experiences such as viral infection, physical injury, pregnancy and childbirth, major life stress, and surgery.
Complications
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One difficulty for people with celiac disease is that a person can have it, but not have any symptoms. Therefore it can take about 4 years, on average, from the time you first experience symptoms to diagnosis. Unfortunately, this delay can cause damage to the small intestine and lead to long-term consequences such as:
- Malnutrition
- Iron-deficiency anemia
- Osteoporosis
- Miscarriage or difficulty having children
- Liver diseases
- Cancer of the intestine
- Cancer of the esophagus (food tube)
- Lymphoma
- Neuropathy
- Increased risk of developing autoimmune disorders (such as thyroid disease or rheumatoid arthritis) and neurological problems (nerve problems causing numbness or pain) or balance problems
Please talk with us right away if you have concerns about any of these risk factors or symptoms.
Prevention and Treatment
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The only treatment for celiac disease is to follow a gluten-free diet. By gluten-free, we mean avoiding all foods and household products that contain gluten. While there is no cure for celiac disease, it is possible to treat or even eliminate your symptoms.
For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements usually begin within weeks of starting the diet, and the small intestine is usually completely healed in 6 to 18 months.
However, for a small number of people, eliminating gluten from their diet does not work to reduce symptoms. In these rare cases, medications may be prescribed to suppress the immune system. There is no surgical procedure that can treat celiac disease.
Why it's important to avoid gluten
If you have celiac disease, you must avoid foods, medications, and household products with gluten because they will eventually cause intestinal damage and possible long-term health problems. This is important even if you do not experience severe symptoms.
We realize that it is challenging to maintain a completely gluten-free diet. There may be times where you accidentally eat gluten. If this happens, we recommend that you try to avoid eating any other foods with gluten in order to limit your exposure.
If your symptoms are severe or do not improve with a gluten-free diet, contact us immediately as this may be a sign of a more serious condition.
How to be gluten-free
For most people with celiac disease, the most effective treatment is a gluten-free diet throughout their lives. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. Gluten is also found in some medications (such as Dimetapp tabs) and household products such as lip balms, envelope glue, and Hasbro's Play-Doh, so you should avoid these as well.
If you have celiac disease, you can still enjoy a well-balanced diet with a variety of foods such as gluten-free bread and pasta. Potato, rice, soy, corn, or bean flour can be used instead of wheat or barley flour. Plain meat, fish, rice, fruits, and vegetables are good choices because they are naturally gluten-free.
Eating a gluten-free diet can take some research and practice, but it may eliminate your symptoms and avoid any damage to the digestive system.
Additional References:
- PDF Link to Celiac Disease - Quick Start Guide
Lifestyle Changes
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While eliminating gluten from your food choices may sound daunting at first, rest assured that many people live with celiac disease and enjoy healthy, productive lives. If you have been diagnosed with celiac disease, here are some tips to help you adjust to your new lifestyle:
- Allow yourself time to adjust to your new gluten-free diet.
- Focus on the delicious and healthy foods that you can eat (fresh fruits, vegetables, poultry, fish, etc.) rather than on foods you must avoid.
- Be wary of processed foods because they often contain hidden sources of gluten.
- Learn how to read the food label. It contains vital information about packaged foods ingredients. You may have to read the ingredient section carefully to ensure that the product is indeed gluten-free.
- In order to become completely gluten-free, it is important to "de-gluten" your kitchen. For example, you may need a separate toaster for your gluten-free bread to avoid cross-contamination if others in your household are eating wheat or other breads with gluten.
- When dining out, tell the wait staff that you have a food intolerance that could make you sick so the food should be prepared exactly as you order it. Some cuisines (such as Mexican, Indian, and Thai) offer many gluten-free dishes. Restaurants may provide specific gluten-free menus.
- Consider meeting with one of our registered dieticians who can help you identify hidden sources of gluten and key nutrients missing in your diet.
- Share your dietary needs with friends and family. By letting people know what your needs are, you can avoid accidentally eating gluten in shared food items.
Additional References:
- Gluten-free Diet
- External Link to Celiac Disease Awareness Campaign
- PDF Link to How to Read the Food Label
Your Care with Me
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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If you are at high risk for developing Celiac Disease you may have regular screening tests.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.
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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
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Coordinating Your Care
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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
If you come to an office visit
- At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need.
- At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
- To help you prepare for your visit, please see additional details under Office Visit.
If I prescribe medications
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
- Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
- Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If I refer you to another specialty colleague
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
If surgery or a procedure is a treatment option
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
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Convenient Resources for You
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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
Manage your care securely
• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
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Related Health Tools:
Interactive Programs
- Online Health Coach Online Health Coach
- Managing Your Back Pain Managing Your Back Pain
Podcasts
- Healthy Living Resources Healthy Living Resources
- Ready to Lose Weight Ready to Lose Weight
- Stress Management for Medical Conditions Stress Management for Medical Conditions
- Weight Loss Weight Loss
Prepare for Your Procedure
- Upper GI Endoscopy (Emmi) Upper GI Endoscopy (Emmi)
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.