This article appeared in the Summer 2007 edition of Celiac.com's Scott-Free Newsletter.

This question, “how early can you diagnose celiac disease?” is a major concern for both parents and paediatricians.  This is because, like many diseases, celiac disease comes on slowly.  This means that it can take a long time to make the diagnosis.

Celiac disease can develop slowly?
Yes, celiac disease can develop very slowly.  The symptoms can be subtle.  It is a progressive disease.  When you are first born, you cannot have celiac disease as you have never been exposed to gluten.  However, if you have the right genetic make up (that is you have the celiac gene) and the right environmental circumstances (eating gluten and getting gut inflammation), then celiac disease can develop.

Finding tissue damage
Celiac disease is a condition that is recognised when you get damage to your small bowel tissue.  This damage is triggered by gluten.

The standard way to detect this tissue damage is by taking a gut biopsy of the small bowel skin (also called the mucosa).  This is done by the technique of upper endoscopy whilst under an anaesthetic.  Tiny fragments of gut tissue are snipped off with a pair of forceps.   This tissue is then sent to a pathology lab.  The lab people (histologists) look down their microscopes at this tissue sample.  They are looking for the gut damage called villous atrophy which is characteristic of disease.

Early antibody changes – IgG-gliadin
Importantly, long before the tissue becomes obviously damaged by gluten, your body can begin to react to the gluten in your diet.

An early sign of a gluten immune reaction is that your body produces