Overview
Coeliac disease is an autoimmune condition in which eating gluten, a protein found in wheat, barley, and rye, triggers an immune reaction that damages the lining of the small intestine. This impairs the absorption of nutrients. A strict lifelong gluten-free diet is the only treatment.
How common is it?
Coeliac disease affects about 1 in 100 people in the UK, though many are undiagnosed. It can develop at any age.
Causes and risk factors
In coeliac disease, the immune system mistakenly attacks the small intestinal lining every time gluten is consumed. Genetic factors are essential: most people with coeliac disease carry specific HLA-DQ2 or HLA-DQ8 genes.
Common risk factors
- HLA-DQ2 or HLA-DQ8 genetic variants
- Family history of coeliac disease
- Other autoimmune conditions (type 1 diabetes, thyroid disease)
- Gut infections in infancy (possibly)
- Infant feeding practices (under investigation)
- Female sex (more commonly diagnosed)
Symptoms
- Diarrhoea or very pale, floating, smelly stools
- Abdominal bloating, pain, and wind
- Unexplained weight loss
- Fatigue and anaemia (due to iron or B12 malabsorption)
- Mouth ulcers
- Skin rash (dermatitis herpetiformis) in some people
- Bone pain and dental problems from calcium malabsorption
- Some people have no digestive symptoms at all
When to see a doctor
See a doctor if you have persistent digestive symptoms, unexplained anaemia or fatigue, or a first-degree relative with coeliac disease. Do not start a gluten-free diet before testing, as this makes diagnosis impossible.
Diagnosis
Blood tests for IgA anti-tissue transglutaminase (tTG) antibodies are the initial test. Upper gastrointestinal endoscopy with duodenal biopsy confirms the diagnosis. Genetic testing helps in atypical cases.
Treatments
Strict lifelong gluten-free diet
The only effective treatment. All wheat, barley, rye, and products containing them must be eliminated. Oats are tolerated by most coeliac patients if certified gluten-free.
Nutritional supplementation
Iron, folate, calcium, vitamin D, and vitamin B12 supplements correct deficiencies that built up before diagnosis.
Follow-up and monitoring
Annual blood tests check for continued antibody levels, nutritional status, and bone density. Dietitian support ensures adequate, varied nutrition on a gluten-free diet.
Self-care and lifestyle
- Read all food labels meticulously as gluten hides in unexpected products
- Use separate cooking utensils and surfaces to avoid cross-contamination
- Join a coeliac support group for practical advice on eating out and travelling
- Inform Coeliac UK or equivalent of airlines, hotels, and restaurants about requirements
Prevention
Coeliac disease cannot be prevented. Screening first-degree relatives of affected individuals is recommended as many have the condition unknowingly.