Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an autoimmune condition where eating gluten triggers your immune system to attack your small intestine. Gluten is a protein found in wheat, barley, and rye. When people with coeliac disease eat gluten, their body treats it as a threat and damages the lining of the small intestine.

This damage affects the tiny finger-like projections called villi that line your intestine. Villi help your body absorb nutrients from food. When they become damaged, your body struggles to absorb vitamins, minerals, and other nutrients properly. This can lead to malnutrition and other health problems over time.

About 1 in 100 people worldwide have coeliac disease. Many people live with it for years without knowing. The only effective treatment is following a strict gluten-free diet for life. Once you stop eating gluten, your intestine can heal and symptoms usually improve within weeks to months.

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Symptoms

Chronic diarrhea or constipation
Abdominal pain, bloating, and gas
Nausea and vomiting
Fatigue and weakness
Weight loss despite normal eating
Iron deficiency anemia
Bone or joint pain
Skin rash called dermatitis herpetiformis
Headaches or brain fog
Tingling numbness in hands and feet

Some people with coeliac disease have no digestive symptoms at all. They may only experience fatigue, anemia, or other subtle signs. Children may show delayed growth or failure to thrive. The wide range of symptoms often leads to delayed diagnosis.

Causes and risk factors

Coeliac disease develops when people with certain genetic markers eat gluten. The HLA-DQB1 gene plays a key role in determining who is at risk. Nearly all people with coeliac disease carry specific variations of this gene. However, having these genes does not guarantee you will develop the condition. About 30% of people carry the genes, but only 3% of those people develop coeliac disease.

Other factors can trigger the disease in genetically susceptible people. These include viral infections, severe stress, pregnancy, surgery, or early childhood feeding practices. Having a family member with coeliac disease increases your risk significantly. Other autoimmune conditions like type 1 diabetes or thyroid disease also raise your likelihood of developing coeliac disease. The exact reason why some people with the genes develop the disease while others do not remains unclear.

How it's diagnosed

Diagnosing coeliac disease typically involves blood tests followed by an endoscopy. Blood tests look for antibodies your immune system makes when you eat gluten. Common antibody tests include tissue transglutaminase antibodies and endomysial antibodies. Genetic testing for HLA-DQB1 gene variations can help rule out coeliac disease if you do not carry the risk genes. However, genetic testing alone cannot diagnose the condition.

If blood tests suggest coeliac disease, your doctor will recommend an endoscopy to confirm the diagnosis. During this procedure, a small sample of your intestinal lining is examined for damage. It is important to keep eating gluten before and during testing. Switching to a gluten-free diet before diagnosis can lead to false negative results. Talk to your doctor about appropriate testing if you suspect you have coeliac disease.

Treatment options

Follow a strict gluten-free diet for life, avoiding wheat, barley, and rye
Read food labels carefully to identify hidden sources of gluten
Take vitamin and mineral supplements to correct deficiencies, especially iron, calcium, vitamin D, and B vitamins
Work with a registered dietitian experienced in coeliac disease
Join support groups to learn practical tips for gluten-free living
Monitor for nutrient deficiencies with regular blood work
Ensure medications and supplements are gluten-free
Be cautious about cross-contamination in kitchens and restaurants
Consider bone density screening if diagnosed as an adult
Follow up regularly with your healthcare provider

Frequently asked questions

Coeliac disease is an autoimmune condition where gluten causes measurable intestinal damage and specific antibody responses. Gluten sensitivity causes symptoms when eating gluten but does not damage the intestine or produce the same antibodies. Both require avoiding gluten, but coeliac disease has more serious long-term health consequences if untreated.

Yes, coeliac disease can develop at any age, even if you have eaten gluten without problems for decades. The condition can be triggered by stress, infection, pregnancy, or surgery in genetically susceptible people. Many adults are diagnosed in their 40s, 50s, or later. If you develop new digestive symptoms or unexplained anemia, ask your doctor about testing.

Yes, people with coeliac disease must follow a strict gluten-free diet for life. There is currently no cure or medication that allows you to safely eat gluten. Even small amounts of gluten can trigger intestinal damage and increase your risk of complications. Most people find that symptoms improve dramatically within weeks of eliminating gluten.

Accidental gluten exposure can cause symptoms within hours or days, including digestive upset, fatigue, and brain fog. The intestinal damage may take weeks or months to heal. Occasional accidents are common when learning to live gluten-free. Return to your strict gluten-free diet immediately and be patient as your body recovers.

No, genetic testing alone cannot diagnose coeliac disease. It can only tell you if you carry the HLA-DQB1 gene variations associated with increased risk. If you do not have these genes, coeliac disease is extremely unlikely. However, having the genes does not mean you have the disease, as many people carry them without developing symptoms.

No, coeliac disease is a lifelong condition. Children diagnosed with coeliac disease will have it for their entire lives. However, with a strict gluten-free diet, their intestines can heal completely and they can grow and develop normally. Regular follow-up with a pediatric gastroenterologist is important for growing children.

Gluten is found in wheat, barley, rye, and products made from these grains. This includes most breads, pastas, cereals, baked goods, and beer. Gluten can also hide in sauces, soups, processed meats, and seasonings. Oats are naturally gluten-free but often contaminated during processing, so choose certified gluten-free oats.

Intestinal healing varies by person and depends on age and severity of damage. Children often heal within 3 to 6 months on a gluten-free diet. Adults may take 2 years or longer for complete healing. Symptoms typically improve within weeks, even before the intestine fully heals. Regular follow-up testing helps monitor your progress.

Yes, first-degree relatives of people with coeliac disease have a 1 in 10 chance of having the condition. This includes parents, siblings, and children. They should be tested even without symptoms, as silent coeliac disease can still cause complications. Genetic testing can help identify family members who need regular screening.

Yes, but you need to take precautions to avoid cross-contamination. Choose restaurants that offer gluten-free menus and train their staff on safe food preparation. Communicate clearly with servers and kitchen staff about your needs. Many restaurants now understand coeliac disease and can prepare safe meals when properly informed.