By Michael Burkholz, DO

How common is celiac disease? What causes celiac disease?


It may surprise you to learn that one out of every 100 people is affected by celiac disease, many of whom are unknowingly living with the disease. That is a fact worth considering as we approach Celiac Awareness Day Sept. 13.

Celiac disease can develop at any point in life. For those with the condition, it results from an immune reaction to eating gluten — a protein found in wheat, barley and rye – that leads to inflammation and damage to the intestines. Celiac disease impacts numerous other systems and functions within the body and may increase the risk for certain long-term health conditions, including cancers of the gastrointestinal tract and intestinal lymphomas, particularly if the condition is left untreated. Early diagnosis can greatly improve your long-term health results.

So how do you know if celiac disease is something you need to check into?

That is a question I had to ask myself three years ago when I decided to get tested and discovered that I was living with celiac’s disease. For me, it was worth checking into because I was experiencing some of the gastrointestinal (GI) symptoms that are common with celiac disease, as well as some of the symptoms people don’t always associate with the condition.

Common symptoms and risk factors of celiac disease


If you have diarrhea or digestive discomfort that lasts for several weeks or more, it is likely worth requesting the simple blood test that can rule out celiac disease. That discomfort could include: changes in bowel movements; diarrhea or constipation; weight loss; bloating and gas; abdominal pain; and nausea or vomiting.

Other common symptoms that are not related to the digestive system can include: headache and fatigue; joint pain; tingling in the hands and feet; itchy, blistering skin; loss of bone density; gum disease; enamel decay and cavities; mouth ulcers; anemia; and other manifestations of vitamin deficiencies. Even neurological and psychiatric problems and complications may be associated with celiac disease.

If you have a relative with celiac disease or type 1 diabetes, you might also be at a higher risk for developing the condition.

You can request the blood test for celiac disease through your physician. To ensure an accurate test result, it’s important to take the test before making changes to your diet. If you have questions or are experiencing complicated symptoms, you may also want to schedule an appointment with a gastroenterologist, a physician specially trained in the function of the GI tract and liver, so that you can benefit from their detailed knowledge of celiac disease and other GI disorders. If you receive a positive test result, you will definitely want to work with a gastroenterologist to confirm your diagnosis and learn how to manage the disease and any potential complications.

Being diagnosed and living with celiac disease


Having been diagnosed with celiac disease myself, I have come to appreciate the implications of this disease first-hand, and I understand how challenging it can be to live with a GI disease. It has made me more of an advocate for my patients as I help them along their journey, working through their symptoms and helping them to eliminate their pain and discomfort and improve their quality of life.

While there are still misconceptions about celiac disease, public awareness of the seriousness of celiac disease has steadily increased in recent years. Celiac disease is a serious condition that causes serious medical complications and has far-reaching effects on the body.

It’s important for anyone who has been recently diagnosed with celiac disease to recognize that it takes time to completely clear their system of the effects of gluten. That is true even for those who are able to strictly follow the dietary modifications that are key to managing celiac disease, namely eliminating any consumption of gluten. It is also important to work with a provider you trust who understands the disease and can provide you with the information and support you need to manage the condition.

Hope for patients with celiac disease


Unfortunately, many patients with celiac disease try to “go it alone” once they feel like they have a handle on their diet. Because celiac disease has such far-reaching effects on the whole body, and on so many different organ systems, it’s important to stay connected to good care. A gastroenterologist can provide support and oversight and can monitor for the secondary issues that even a well-managed case of celiac disease can cause, such as the effects of micronutrient deficiencies. At a minimum, a patient with celiac disease should be seen by a GI specialist annually or semi-annually.

If you are struggling with celiac disease, remember: You’re not alone. As someone who regularly treats celiac disease, and lives with the disease every day of my life, I can assure you that with the right support and diet, it is possible to live a very normal lifestyle. There are also many resources that your physician can connect you with that offer support and insight into how to optimize your health and quality of life. With early diagnosis and continued treatment, you can live well with celiac disease, and you can thrive.

Associates in Gastroenterology “Top Docs” Speak Out

Associates in Gastroenterology is proud of its team of highly qualified, experienced and caring GI physicians. It comes as no surprise that more than a third of AG’s providers were recognized this year as “Colorado Springs Top Doctors 2021” by Colorado Springs Magazine. Dr. Cesario, Dr. Garza, Dr. Kavanaugh and Dr. Lunt were chosen this year to be recognized by their peers as being at the peak of excellence in their fields of practice. Read below to learn more about our “Top Docs” and to hear from them on how they approach care for their patients.

Dr. Karin Cesario

Karin Cesario, MD

Dr. Cesario was recognized as a Top Doc in transplant hepatology. She studied at Washington University in St. Louis and then completed her medical education and training at the University of Colorado and the Cleveland Clinic. She remains the only transplant hepatology trained and boarded physician in Colorado Springs. She treats the entire spectrum of liver disease with compassion and excellence in her very in-demand clinical practice.

What is your specialty?

I am a transplant hepatologist, which means that I take care of patients with serious liver conditions, both before and after liver transplantation. 

What makes you passionate about your work, and what kind of impact do you hope to make in the lives of your patients?

I hope to impact the lives of my patients by educating them on how to best take care of their liver. For those with end-stage liver disease, I can help navigate the liver transplant process.  

What do you find to be the most interesting and enjoyable aspect of being a physician?

The most enjoyable part of being a hepatologist is my patients. They are the best! Many have been through difficult times and work very hard to get better. 

What are your hopes for the future of your profession?

My biggest hope for hepatology is to broadly educate our community and remove the stigma of liver disease. Yes, liver disease can result from heavy drinking, drug use or poor diet management, but it can also be the result of genetics, or even bad luck. Many people are at risk of developing liver disease whether they know it or not.

What words of encouragement would you offer someone who is struggling with liver disease?

Liver disease is treatable and, in many cases, curable.  Anyone who is concerned about their liver should seek the help of a professional. 


Dr. Austin Garza

Austin Garza, MD

Dr. Garza was recognized as a Top Doc in gastroenterology. He completed his undergraduate and medical education at Vanderbilt University. He has a special interest in esophageal disease and GI malignancy. He also has performed over a thousand endoscopic ultrasound (EUS) procedures at Penrose Hospital, where he serves on the Credentials Committee. He currently serves as the president of our practice and regularly attends national meetings and works with elected officials and representatives in Congress as part of the Digestive Health Physicians Association. 

What is your specialty?

I practice general gastrointestinal (GI) care, but have a special interest in treating esophageal disease. This includes esophageal motility issues, allergic disorders, esophageal cancer, and gastroesophageal reflux disease (GERD). This interest comes from my training days in Tampa spent learning under the legendary Dr. Worth Boyce, a true pioneer in treating esophageal disease. He was a master clinician and loved teaching. I am privileged to have known him.

What makes you passionate about your work, and what kind of impact do you hope to make in the lives of your patients?

Every day is truly a new day, with new personal stories and connections. No two patients are ever the same, and I look forward to each day’s new interactions and conversations. Hopefully at the end of the day I’ve helped in some way. It’s a privilege to do this for a living – I love my job.

What do you find to be the most interesting and enjoyable aspect of being a physician?

I think the gut has more bearing on one’s overall health than any other body system, and most patients appreciate this on some level. I think awareness of nutrition, diet, and gut health has never been better. I love GI because we have longitudinal relationships – we aren’t just doing a procedure or seeing someone at a moment of distress. We can help patients with disease management over many years. With GI cancers, we can find them early, before they are even cancer (e.g. colon polyps, Barrett’s Esophagus), help treat them, and prevent these malignancies from shortening a person’s life. That’s a powerful thing.

What are your hopes for the future of your profession?

I hope medicine as a whole doesn’t become more corporate. At Associates in Gastroenterology, we are an independent practice, and have resisted the buy-outs from private equity or hospital systems that other groups have undergone. We answer only to our patients and our employees. Our motivations and goals for practicing medicine remain treating patients to the best of our abilities, and nothing else. I am also hopeful that we will have more physicians enter into practice in our country. This is true in all specialties, but in GI in particular. The US will be about 2,000 GI doctors short of demand in just 4 years (by 2025). I am hopeful that the lack of access to care will be short-lived as more students become inspired to join this very fulfilling line of work.

What words of encouragement would you offer someone who is struggling from GI discomfort or pain?

Don’t put off getting that colonoscopy, or any screening test of importance. We saw this especially during the early days of COVID when people were sitting on very worrisome symptoms due to fear of venturing out. A recent article in Spain reported a “decrease” in colon cancer diagnoses of 40% since the beginning of COVID. The cancer is still occurring like it always has, it’s just not getting caught at early and treatable stages. Spain saw a decrease in colon and breast cancer screenings of nearly 85% and 90%, respectively. As COVID recedes, this upcoming wave of soon-to-be diagnosed late-stage cancers will be the next unfortunate “pandemic” for many countries. Don’t ignore your body, and don’t put off seeing a doctor.


Dr. Bryan C Kavanaugh

Bryan Kavanaugh, MD

Dr. Kavanaugh was recognized as a Top Doc in gastroenterology. He has provided quality and compassionate care in Colorado Springs for more than 10 years. Similar to his current recognition as a Top Doctor, he was frequently recognized for clinical excellence during his training years at Georgetown Medical School and Thomas Jefferson Hospital. He received multiple awards including being selected as chief resident. He treats all aspects of GI disease, from IBD to IBS, and he performs the full spectrum of endoscopic procedures, from advanced biliary endoscopy to highly appreciated therapies for hemorrhoids.

What is your specialty?

I specialize in management of all gastrointestinal (GI) illnesses, with an interest in treating functional bowel disorders, such as IBS, bloating, constipation and diarrhea.

What makes you passionate about your work, and what kind of impact do you hope to make in the lives of your patients?

I love helping people get better and finding ways to help them improve their health through medications, diet and lifestyle changes.

What do you find to be the most interesting and enjoyable aspect of being a physician?

How open people are with their issues and their willingness to share personal experiences. It’s remarkable how many tearful patients I have seen. It emphasizes for me how important it is to do my best to help them overcome the physical cause of their struggles. 

What are your hopes for the future of your profession?

That we will continue to find therapies to help people deal with chronic illnesses like Crohn’s disease, ulcerative colitis, and celiac disease.

What words of encouragement would you offer someone who is struggling from GI discomfort or pain?

While many of these symptoms may not be life threatening, there is no reason to live in fear of evaluation of these symptoms. There is no reason to suffer through symptoms that may be easily explained, especially when we have good treatments available to alleviate those symptoms. 


Dr. William Lunt

William Lunt, MD

Dr. Lunt was recognized as a Top Doc in gastroenterology. He offers our patients expertise in multiple areas of advanced endoscopy, as well as offering life-changing therapies for fecal incontinence. He is a native Coloradoan, avid skier, kayaker and outdoor enthusiast. He has been a physician leader for many years, directing our endoscopy center since its inception in 2005, and in a recurring role as the physician director for the GI labs at Penrose and St. Francis hospitals.

What is your specialty?

My specialty is gastrointestinal (GI) disease and hepatology, which is the study of all liver-related diseases. I have an interest in treating reflux disease, swallowing difficulties, inflammatory bowel disease (IBD) and all other gut-related problems. I am very interested in treating chronic liver disease and liver cancer. I also work very closely with patients with pancreatic disease and cancer. My special interest, however, is helping people overcome fecal incontinence with exciting treatments to regain full bowel and bladder control. 

What makes you passionate about your work, and what kind of impact do you hope to make in the lives of your patients?

What makes me passionate about my work is the tremendous help I can do for patients. I love my job and love taking care of patients. There is tremendous satisfaction when I am able to help or cure someone and improve their quality of life. That is why I am a doctor. 

What do you find to be the most interesting and enjoyable aspect of being a physician?

The most interesting part of my job is the honor that comes with taking care of individuals and having that very close caring relationship. There are so many diseases and problems that affect the intestines and liver that it gives me many opportunities to see and help a wide variety of people.

What are your hopes for the future of your profession?

For me, it is always about the patient and helping them to feel better, and I will continue to do everything possible to keep that as the focus of my practice. 

What words of encouragement would you offer someone who is struggling from GI discomfort or pain?

I see many people daily who are in dire need of medical help. If someone reading this has been silently suffering, I would encourage them to see someone for help. There is always help for any medical problem, and often there can be a benefit to getting that help sooner, rather than later.