If you have celiac disease, your doctor has likely told you that adhering to a strict gluten-free diet is the only way to eliminate symptoms, repair damage to your small intestine and prevent further injury. Medical experts agree on the importance of a gluten-free diet, but patients often have questions about the damage already done to the villi of the small intestine and the process the body has for repairing that damage.
Villi Damage and Antibodies
In someone with celiac disease, eating foods containing gluten causes a reaction in the villi of the small intestine. Villi are tiny, finger-like projections that line the inside of that organ. For a person with celiac disease, eating gluten flattens the villi and makes them unable to absorb nutrients effectively.
When a person with celiac disease eats gluten, his or her body produces specific antibodies that can be detected through a blood test. A positive antibody blood test is the first step in diagnosing the disease. If a patient has elevated antibody levels, the next step is to do a biopsy of the small intestine to look for villi damage. The amount of damage in a newly diagnosed celiac is difficult to predict, but several research studies report a relationship between factors such as physical symptoms and tTG levels at diagnosis and the severity of villi damage.
Correlation Between Villi Damage, Physical Symptoms and Blood Test Results
A Finnish study conducted in 2012 confirmed the importance of considering a patient's physical symptoms and quality of life when first making a celiac disease diagnosis. There was a distinct correlation between initial physical discomfort, the level of antibodies in the blood and the degree of damage in the small intestine for many of the patients studied. This means that adults who have been ignoring the symptoms of "active" celiac for years could have extensive villi damage by the time of diagnosis.
Correlation Between High tTG Antibody Numbers and Severe Villi Damage
According to an Italian study, the tTG antibody test was shown to be the most sensitive for diagnosing most patients. The study found a definite relation between the overall tTG antibody number and the degree of villi damage as seen through a biopsy.
Measuring Damage to the Villi
When a person with celiac disease eats gluten, either on purpose or more likely by accident, he or she will often experience physical symptoms such as stomach upset, headache, muscle pain or fatigue within a few hours. Such symptoms may last for several days before they subside. Others may eat gluten occasionally and experience no physical symptoms at all. The existence or lack of physical symptoms is not a good indication of villi damage, however. Calculating the damage that eating gluten does to the villi is not that simple.
All Gluten Consumption Damages the Villi
Every time a person with celiac disease eats gluten, it causes new damage to the villi. The amount of damage depends on how much and how often gluten is eaten and the patient's own specific physiology. The only way to definitively "see" and measure damage to the villi is through a biopsy of the small intestine, which is usually only performed at diagnosis. According to the University of Chicago Celiac Disease Center, post-diagnosis damage is measured with a yearly blood test to check antibody levels. If antibody levels remain normal, doctors assume that the patient is not ingesting any gluten and thus, not causing new damage to the villi.
Higher Antibodies Indicate Regular Exposure to Gluten
Although even a single instance of gluten ingestion will cause some damage to the villi, it is unlikely to be measurable in the form of higher antibodies. The University of Chicago Celiac Disease Center reports that repeated exposure to gluten will cause antibody numbers to rise, which usually takes two or three months of regular gluten ingestion. If an individual has been gluten-free for at least six months and is not seeing a drop in antibody numbers, it is likely that he or she is still eating gluten somewhere. Most doctors will recommend watching out for cross-contamination and other accidental gluten before looking for other causes of the continued high antibody levels.
Healing Damaged Villi
Your villi will begin to heal as soon as you start a strict gluten-free diet; however, the healing process can take time. According to the National Institute of Health, children tend to heal more quickly than adults, so a child on a strict gluten-free diet should see normal antibody levels within three to six months of going gluten-free. It may take an adult up to two years for antibody levels to return to normal. However, taking care of yourself, adhering to your diet, and working closely with your doctor will have you on the road to recovery.