Coeliac disease

About coeliac disease

In the UK, around one in 100 people are thought to have coeliac disease. However, many people have it for years without it being diagnosed. Coeliac disease affects twice as many women as men and can occur at any age.

Coeliac disease affects your small bowel. The lining of your small bowel is made up of tiny finger-shaped projections called villi. If you have coeliac disease and eat foods that contain a protein called gluten, your villi become inflamed and flattened. The damage caused decreases the surface area of the villi and stops your small bowel absorbing nutrients and minerals from food properly. Gluten is harmless to people who don't have coeliac disease.

People who have coeliac disease are more at risk of developing an associated condition – for example, Sjogren's syndrome, type 1 diabetes, or Addison's disease.

Symptoms of coeliac disease

Symptoms of coeliac disease can vary from being mild to severe – or you may not have any symptoms at all. The symptoms may be similar to conditions such as irritable bowel syndrome and Crohn's disease. If you have coeliac disease, you may have symptoms including:

  • diarrhoea or constipation
  • vomiting or feel sick
  • a bloated abdomen (tummy)
  • excessive wind
  • pain or cramps in your abdomen
  • sudden or unexplained weight loss (although you can also be overweight and have coeliac disease)

You may also have symptoms unrelated to your digestive system, such as:

  • hair loss (alopecia)
  • mouth ulcers
  • a rash on your skin
  • tiredness
  • headaches

Young children with coeliac disease may find it difficult to gain weight, have delayed growth and appear irritable.

If you have any of these symptoms, see your GP.

Complications of coeliac disease

If you don’t have treatment for coeliac disease, it may lead to:

  • a deficiency in iron (anaemia) and other vitamins or minerals
  • reduced growth in children
  • reduced fertility in both men and women
  • an increased risk of developing osteoporosis or osteopenia – conditions in which your bones become weakened and are more likely to break
  • an increased risk of developing epilepsy
  • a small, increased risk of developing certain cancers, such as small bowel cancer and oesophageal cancer

If you stick to a gluten-free diet, it will reduce your risk of developing these complications.

Causes of coeliac disease

Coeliac disease is caused by your body reacting to gluten, which is found in foods that contain wheat, barley and rye, such as bread and pasta.

Coeliac disease is an autoimmune condition. Your immune system makes proteins called antibodies that attack harmful substances. If you have coeliac disease, your body mistakes gluten for a harmful substance and produces antibodies to fight it. This reaction causes damage to the lining of your small bowel.

The exact reasons why you may develop coeliac disease aren’t fully understood at present. It may be inherited – one in 10 people who have coeliac disease have a brother, sister or mother who has the condition. If members of your immediate family have coeliac disease and you think you may have symptoms, you can take a test to find out if you have it too. However, if you do have a relative with coeliac disease it doesn’t necessarily mean that you will get it too, other factors are thought to be involved. These include having previously had an infection in your digestive system, such as a rotavirus infection or having another health condition such as ulcerative colitis or type 1 diabetes.

It may also be that your diet as a baby can make you more likely to get coeliac disease. If parents introduce gluten into their baby’s diet before they are three months old, it can increase their risk of developing coeliac disease. The UK Government recommends that parents only introduce solid foods after their baby is six months.

Diagnosis of coeliac disease

Your GP will ask about your symptoms and examine you.

Your GP may advise you to have a blood test to look for certain antibodies that are present in people with coeliac disease. You will need to eat some gluten in at least one meal every day for a minimum of six weeks before you’re tested. If the tests show you have the antibodies, your GP may refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system), who may suggest you have an intestinal biopsy.

In an intestinal biopsy, your doctor will pass a narrow, flexible, tube-like telescopic camera called an endoscope down your oesophagus (the pipe that goes from your mouth to your stomach). He or she will take a small sample of the lining of your bowel. The tissue will be sent to a laboratory for testing.

Treatment of coeliac disease

There isn’t a cure for coeliac disease but if you eat a diet that doesn’t contain gluten (a gluten-free diet) this should make your symptoms go away. You may find your symptoms disappear in as little as a few weeks after you cut gluten out completely. If you stick to a gluten-free diet, it will also help reduce your risk of developing other, closely related, long-term diseases, such as osteoporosis.

Gluten is found in all foods that are made using wheat, barley or rye. As a general guide, don't eat bread, pastry, cakes, pasta, pizza bases, biscuits, most cereals or processed foods, such as sausages, soups and sauces. Once you start to check the gluten content of foods, you will get to know what you can and can't eat.

Some food manufacturers make gluten-free products for people with coeliac disease. You may be able to find gluten-free bread, biscuits and pasta in the supermarket or health food shops. Some may be available on prescription.

If you're eating in a restaurant and the menu doesn't offer gluten-free options, you may have to ask. If in doubt, don't eat something you're unsure about.

Your doctor may refer you to a dietitian who will help you plan your gluten-free diet. If you have just been diagnosed with coeliac disease, your dietitian may advise you to take some vitamin and mineral supplements until you have settled into your new diet.

Prevention of conditions associated with coeliac disease

Osteoporosis

If you're diagnosed with coeliac disease, your GP may recommend that you have a dual x-ray absorptiometry (DXA) scan to check the density of your bones. The scan can help look for signs of fragile bones and will help to assess your risk of developing fractures. You may need to have another scan if you have a fracture at any point during your life, and when you reach the menopause for women, or 55 years of age for men. Your doctor may also suggest you do regular physical activity, reduce your alcohol intake and include a calcium supplement in your diet to strengthen your bones.

For more information please see our Related topics.

Infections

Coeliac disease can sometimes affect your immune system, so you’re less able to fight infections. Your GP may suggest you have vaccinations against influenza, pneumococcus and haemophilus influenza type B.

Living with coeliac disease

Coeliac disease is a life-long condition, so you will need to have regular check-ups (once a year) with your GP or gastroenterologist. You may need blood tests to see if your body is absorbing enough nutrients.

Charities and patient groups that focus on coeliac disease can be an invaluable source of support and advice to help you live with your condition.

What if I eat something that contains gluten without realising?

Answer

There is a chance you may react to the gluten, but you may not.

Explanation

If you eat something that contains gluten, your symptoms may return but this depends on how severe they were to begin with and how much gluten you have eaten. The threshold for a reaction also varies between individuals. You may not have any noticeable symptoms but this doesn't mean your body hasn’t reacted to the gluten, and there may still be damage to the lining of your small bowel. It’s important to always check what you’re eating and try to maintain a gluten-free diet.

Can I eat foods labelled 'gluten free', 'very low gluten' and 'wheat free'?

Answer

Foods labelled 'gluten free' are generally safe for most people with coeliac disease to eat. However, foods labelled 'very low gluten' may not be safe for everyone and 'wheat free' doesn't necessarily mean gluten free.

Explanation

In January 2012, the rules about how all food can be labelled, changed. This includes food in a supermarket, in a restaurant, or at a deli counter.

Foods can be labelled gluten free if they contain less than 20 parts per million of gluten – these are suitable for most people with coeliac disease. Foods labelled 'very low gluten' are made with a special type of modified starch and contain very little gluten (up to 100 parts per million). Some people with coeliac disease may have a reaction to 'very low gluten' foods. Consult your dietitian before introducing 'very low gluten' foods into your diet.

Foods labelled 'wheat free' aren't the same as 'gluten free' or 'very low gluten'. Wheat free foods may have other cereals, such as barley or rye in them, so they aren't suitable for people with coeliac disease.

If you're in doubt as to whether something is safe or not, it’s best not to eat it. Ask your dietitian for further advice and information.

Will having coeliac disease shorten my life?

Answer

No, coeliac disease won’t affect your life expectancy, providing you stay on a gluten-free diet.

Explanation

If you maintain a gluten-free diet, it will help to keep your small bowel healthy. If you have coeliac disease, there is a small risk of developing complications, such as osteoporosis, but this is reduced if you stick to a gluten-free diet.

Will coeliac disease stop me having children?

Answer

No, coeliac disease only affects fertility if it isn't treated.

Explanation

Coeliac disease affects finger-like projections called villi, which line your small bowel. If you have coeliac disease and eat food that contains the protein gluten, your villi become damaged and inflamed. This damage can stop your small bowel absorbing food properly so you don’t absorb normal levels of nutrients and minerals into your body. This can affect your fertility.

Once you start your gluten-free diet, any problems caused by coeliac disease, including fertility problems, should gradually subside.

What’s the difference between coeliac disease and a wheat allergy?

Answer

Coeliac disease is linked to wheat because wheat contains gluten and this causes the symptoms of coeliac disease. However, coeliac disease isn’t the same as having a wheat allergy, they are two distinct conditions.

Explanation

Coeliac disease is an autoimmune condition where your body mistakes gluten for a harmful substance and produces antibodies to fight it. This immune response can damage the lining of your small bowel.

If you have a wheat allergy, your immune system will also react but a different type of antibody is involved and this will often happen immediately after you eat wheat. This can cause similar symptoms to those of coeliac disease, such as abdominal (tummy) pain and a change in bowel movements, but you will only have symptoms for a short time after eating wheat. You may have a mild or a severe reaction but it won’t cause the inflammation to your small bowel in the way coeliac disease does.

If you’re unsure if you have a wheat allergy or coeliac disease, see your GP.