Crohn’s vs. Celiac
Written on October 5, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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According to the Celiac Disease Foundation, celiac disease and Crohn’s disease are both diseases that deal with inflammation of the intestines. Because abdominal pain and diarrhea are symptoms of both, differentiation between Crohn’s disease and celiac disease can be difficult. It is often left to blood tests, as well as endoscopy and biopsy, to determine which disease is present.
Blood tests for celiac disease and Crohn’s look for different characteristics, so doctors are able to distinguish between the two based on results. Unlike Crohn’s disease, celiac disease symptoms usually disappear when patients adhere to a gluten-free diet.
Even with some conflicting data, most studies conclude that celiac disease is more common in Crohn’s patients. Researchers believe the prevalence of Crohn’s disease is higher than ulcerative colitis in patients with celiac disease.[1]
Let’s take a closer look at Crohn’s vs. celiac to reveal what they have in common and how they are different.
Celiac Disease
Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley, and rye.
If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption). There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.
Symptoms
The signs and symptoms of celiac disease can vary greatly and differ in children and adults. Digestive signs and symptoms for adults include:
- Diarrhea
- Fatigue
- Weight loss
- Bloating and gas
- Abdominal pain
- Nausea and vomiting
- Constipation
However, more than half the adults with celiac disease have signs and symptoms unrelated to the digestive system, including:
- Anemia, usually from iron deficiency
- Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Mouth ulcers
- Headaches and fatigue
- Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
- Joint pain
- Reduced functioning of the spleen (hyposplenism)
Children
Children with celiac disease are more likely than adults to have digestive problems, including:
- Nausea and vomiting
- Chronic diarrhea
- Swollen belly
- Constipation
- Gas
- Pale, foul-smelling stools
The inability to absorb nutrients might result in:
- Failure to thrive for infants
- Damage to tooth enamel
- Weight loss
- Anemia
- Irritability
- Short stature
- Delayed puberty
- Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures
Dermatitis Herpetiformis
Gluten intolerance can cause an itchy, blistering skin disease. The rash usually occurs on the elbows, knees, torso, scalp, and buttocks. This condition is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the skin condition might not cause digestive symptoms.
Doctors treat it with a gluten-free diet, medication, or both to control the rash.
When To See A Doctor
Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Consult your child's doctor if your child is pale, irritable, or failing to grow or has a potbelly and foul-smelling, bulky stools.
Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you're tested for celiac disease, you can change the test results.
Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also, ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.
Diagnosis
Many people with celiac disease don't know they have it. Two blood tests can help diagnose it:
- Serology testing to look for elevated levels of certain antibody proteins that indicate an immune reaction to gluten
- Genetic testing for human leukocyte antigens can be used to rule out celiac disease
If the results of these tests indicate celiac disease, your doctor will likely order one of the following tests:
- Endoscopy
- Capsule endoscopy
If your doctor suspects you have dermatitis herpetiformis, he or she might take a small sample of skin tissue to examine under a microscope (skin biopsy).
Treatment
A strict, lifelong gluten-free diet is the only way to manage celiac disease. Besides wheat, foods that contain gluten include:
- Barley
- Bulgur
- Durum
- Farina
- Graham flour
- Malt
- Rye
- Semolina
- Spelt (a form of wheat)
- Triticale
A dietitian who works with people with celiac disease can help you plan a healthy gluten-free diet. Even trace amounts of gluten in your diet can be damaging, even if they don't cause signs or symptoms.
Gluten can be hidden in foods, medications, and nonfood products, including:
- Modified food starch, preservatives, and food stabilizers
- Prescription and over-the-counter medications
- Vitamin and mineral supplements
- Herbal and nutritional supplements
- Lipstick products
- Toothpaste and mouthwash
- Communion wafers
- Envelope and stamp glue
- Playdough
Removing gluten from your diet will gradually reduce inflammation in your small intestine, causing you to feel better and eventually heal. Children tend to heal more quickly than adults.
Vitamin and Mineral Supplements
If your anemia or nutritional deficiencies are severe, your doctor or dietitian might recommend that you take supplements, including:
- Copper
- Folate
- Iron
- Vitamin B-12
- Vitamin D
- Vitamin K
- Zinc
Vitamins and supplements are usually taken in pill form. If your digestive tract has trouble absorbing vitamins, your doctor might give them by injection.
Follow-Up Care
Medical follow-up at regular intervals can ensure that your symptoms have responded to a gluten-free diet. Your doctor will monitor your response with blood tests.
For most people with celiac disease, a gluten-free diet will allow the small intestine to heal. For children, that usually takes three to six months. For adults, complete healing might take several years.
If you continue to have symptoms or if symptoms recur, you might need an endoscopy with biopsies to determine whether your intestine has healed.
Medications To Control Intestinal Inflammation
If your small intestine is severely damaged or you have refractory celiac disease, your doctor might recommend steroids to control inflammation. Steroids can ease severe signs and symptoms of celiac disease while the intestine heals.
Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris), might be used.
Treating Dermatitis Herpetiformis
If you have this skin rash, your doctor might recommend a medication such as dapsone, taken by mouth, as well as a gluten-free diet. If you take dapsone, you'll need regular blood tests to check for side effects.
Refractory Celiac Disease
If you have refractory celiac disease, your small intestine won't heal, and you'll likely need to be evaluated in a specialized center. Refractory celiac disease can be quite serious, and there is currently no proven treatment.[2]
Crohn’s Disease
A type of inflammatory bowel disease (IBD), Crohn’s disease causes your digestive tract to become
swollen and irritated. This is a life-long condition that cannot be cured. However, treatments typically help
manage your symptoms and allow you to live an active life.
Crohn’s disease typically appears in younger people — often in their late teens, 20s or early 30s. However, this condition can happen at any age. It’s equally common in men and women. Crohn’s disease can also be seen in young children.
If you’re a cigarette smoker, your risk of Crohn’s disease might be higher than that of non-smokers.
People with Crohn’s disease can experience periods of severe symptoms (flare-ups) followed by periods of no or very mild symptoms (remission). Remission can last weeks or even years. There’s no way to predict when flare-ups will happen.
Symptoms
If you have Crohn’s disease, symptoms you might have can include:
- Abdominal pain
- Chronic diarrhea
- A feeling of fullness
- Fever
- A loss of your appetite
- Weight loss
- Abnormal skin tags (usually on your buttocks)
- Anal fissures
- Anal fistulas
- Rectal bleeding
Diagnosis
Most people with Crohn’s first see a healthcare provider because of ongoing diarrhea, belly cramping, or unexplained weight loss. If you have a child who has been experiencing the symptoms of Crohn’s disease, reach out to your pediatrician.
To find the cause of your symptoms, your healthcare provider may order one or more of these tests:
- Blood test
- Stool test
- Colonoscopy
- Computed tomography (CT) scan
- Upper gastrointestinal (GI) endoscopy
- Upper gastrointestinal (GI) exam
Management And Treatment
Treatment for Crohn’s disease varies depending on what’s causing your symptoms and how severe they are for you. In children, the goal of treatment is to induce remission (the time between symptom flare-ups), maintain remission, and manage any complications of Crohn’s disease over time.
Your healthcare provider may recommend one or more of these treatments for Crohn's disease [3]:
- Antibiotics
- Antidiarrheal medication
- Monoclonal antibodies to suppress the immune response
- Bowel rest
- Corticosteroids
- Immunomodulators
- Surgery
How Everlywell Can Help
Everlywell offers an at-home Celiac Disease Screening Test. This at-home lab test checks for antibodies that may indicate celiac disease. If your results show that you may have an increased risk of celiac disease, our patient care team will reach out to you about next steps.
You may also schedule a telehealth visit to address your symptoms with the right test, prescriptions, or lifestyle recommendations. (Age 18+)
Related Content
The Link Between Celiac Disease and Anemia
How To Know If You Have Celiac Disease
IBS vs. Celiac Disease vs. Gluten Sensitivity: Understanding the Differences
References
- Crohn’s Disease. Celiac Disease Foundation. https://celiac.org/about-celiac-disease/related-conditions/crohns-disease/. Accessed on 9/8/2023.
- Celiac Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225. Accessed on 9/8/2023.
- Crohn’s Disease. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9357-crohns-disease. Accessed on 9/8/2023.