What is Coeliac Disease?

If you’ve recently been diagnosed with coeliac disease, you might be wondering, What exactly is it?  You’re not alone many people, including myself, had never heard of it before their diagnosis.

What is it?

Coeliac disease is a serious autoimmune condition, not a food allergy or intolerance. When someone with coeliac disease eats gluten a protein found in wheat, barley, and rye their immune system mistakenly attacks the lining of the small intestine. Even tiny traces of gluten from cross-contamination can cause this reaction.

This damage affects the villi, small finger-like projections in the gut responsible for nutrient absorption. When the villi are flattened or destroyed, the body can no longer absorb essential nutrients properly, leading to malnutrition, weight loss, and a wide range of health issues.

What Are the Symptoms of Coeliac Disease?

Symptoms vary from person to person, in both type and severity. Some people have severe digestive issues, while others experience non-digestive symptoms or none at all.

Common Symptoms:

• Diarrhoea, constipation, or both

• Bloating and excessive gas

• Abdominal pain or discomfort

• Indigestion

• Vomiting

• Anaemia

• Fatigue and tiredness

• Mouth ulcers

• Headaches or migraines

• Joint pain

• Missed periods

• Osteoporosis

• Brain fog or cognitive issues

• Itchy rash (dermatitis herpetiformis)

• Tingling or numbness in hands/feet

• Infertility

• Liver abnormalities

• Recurrent miscarriages

  
  
  
  

• Issues with coordination, balance, and speech

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Three Types of Symptom Presentations:

1. Classical Coeliac Disease:Includes diarrhoea, vomiting, weight loss, and growth failure in children.

2. Non-Classical Coeliac Disease:Involves mild gastrointestinal symptoms and non-digestive symptoms like iron deficiency, fatigue, vitamin deficiencies, chronic migraines, reduced bone mass, and fertility issues.

3. Silent (Asymptomatic) Coeliac Disease:No obvious symptoms, but damage to the small intestine is still present. Interestingly, many people in this group report improvements in general health, bloating, and reflux once on a gluten-free diet.

   
   

How Is Coeliac Disease Diagnosed?

Diagnosis typically involves:

1. Blood Tests:These check for specific antibodies (e.g., tTG-IgA) produced in response to gluten consumption.

2. Biopsy:If blood tests are positive, a specialist usually a gastroenterologist

   
   
   
   

   will perform an endoscopy and take a biopsy of the small intestine to confirm the diagnosis.

Important: You must continue eating gluten until all testing is complete, or results may be inaccurate.

What Happens After Diagnosis?

After a confirmed diagnosis:

• You’ll usually be referred to a dietitian to help you transition to a strict gluten-free diet.

• A DEXA scan (bone density scan) may be recommended to check for osteoporosis, as nutrient malabsorption can affect bone health.

• Ongoing monitoring is advised, especially by a dietitian and gastroenterologist, to manage nutrient levels and gut healing.

• Annual blood tests, you should have annual blood tests to assess your antibodies, vitamin levels etc. Often doctors do not chase you up on this and you end up having to chase them for annual blood tests.

Helpful Resource: Coeliac UK has a helpline if you need advice: 0333 332 2033

What Causes Coeliac Disease?

Coeliac disease is triggered by an abnormal immune response to gliadin, a protein found in gluten. The immune system sees this protein as a threat, attacking the lining of the small intestine.

The gut is lined with villi, which increase surface area for nutrient absorption. In coeliac disease, these villi become inflamed and flattened, severely impacting digestion and leading to deficiencies.

Risk Factors for Developing Coeliac Disease

1. Genetics

• Coeliac disease often runs in families.

• First-degree relatives (parent, sibling) have a 10% chance of developing it.

• Identical twins show a 75% likelihood.

2. Environmental Triggers

• Early childhood digestive infections may increase risk.

• Introducing gluten to babies before 6 months of age may contribute to a higher chance of developing coeliac disease.

3. Stress and Life Events

• Research suggests a potential link between stressful life events and the onset of coeliac disease.

• A study from Italy found that newly diagnosed patients were more likely to have experienced a major life event (e.g. trauma, pregnancy, or illness) in the year before diagnosis compared to a control group with non-autoimmune digestive conditions.

• Women appeared to be more affected by stress-related triggers, particularly around pregnancy.

While stress is not a direct cause, it may play a role in triggering the disease in genetically predisposed individuals.