Coeliac disease

Overview

Coeliac disease (pronounced SEE-lee-ak) is a condition where your immune system attacks your own body when you eat gluten. Gluten is a protein found in wheat, barley, and rye. This attack damages the lining of your small intestine, which can stop your body from absorbing nutrients properly. It is not a food allergy or an intolerance — it is an autoimmune disease, meaning your immune system mistakenly harms healthy tissue.

Coeliac disease affects about 1 in 100 people worldwide, but many are not diagnosed. It is one of the most common lifelong conditions in the world.

Coeliac disease can affect people of all ages, genders, and ethnicities. It is more common in people with a family history of the condition or certain autoimmune diseases, such as type 1 diabetes or autoimmune thyroid disease.

Symptoms

Common symptoms

• Diarrhoea (loose, fatty, foul-smelling stools)
• Bloating and gas
• Stomach pain
• Fatigue (extreme tiredness)
• Weight loss
• Anaemia (low iron levels, causing weakness and pale skin)
• Bone or joint pain
• Mouth ulcers
• Itchy, blistering skin rash (dermatitis herpetiformis)

Symptoms in children

• Poor growth or delayed puberty
• Chronic diarrhoea or constipation
• Bloated belly
• Irritability and mood changes
• Pale, foul-smelling stools
• Weight loss or failure to gain weight

Symptoms in older adults

• Fatigue and weakness
• Bone or joint pain
• Mouth ulcers
• Unexplained weight loss
• Anaemia (low iron levels)
• Dermatitis herpetiformis (itchy skin rash)

Causes

Main causes

• Eating gluten triggers an immune reaction in people with a genetic predisposition.
• The immune system attacks the lining of the small intestine, causing inflammation and damage.
• Genes (HLA-DQ2 and HLA-DQ8) are strongly linked to coeliac disease, but not everyone with these genes develops the condition.

Risk factors

• Family history (parent, sibling, or child with coeliac disease)
• Having another autoimmune condition (like type 1 diabetes, autoimmune thyroid disease, or rheumatoid arthritis)
• Down syndrome or Turner syndrome
• Long-term use of certain medications (like some antibiotics or antivirals) — but this is less common

When to see a doctor

See a doctor urgently if:

• You have severe abdominal pain, vomiting, or signs of dehydration (dry mouth, dark urine, dizziness).
• You have a sudden, unexplained loss of weight.
• You have symptoms of severe anaemia (very tired, breathless, pale).

Book a routine appointment if:

• You have ongoing diarrhoea, bloating, or stomach pain that lasts more than a few weeks.
• You feel tired all the time for no clear reason.
• You have mouth ulcers that keep coming back.
• Your child is not growing as expected, has diarrhoea, or seems irritable.
• You have a skin rash that is itchy and blisters (you may need a specialist).

Diagnosis

Coeliac disease is usually diagnosed with a blood test first, then confirmed with a small biopsy (taking a tiny sample of tissue) from your small intestine. You must be eating gluten (at least one slice of bread per day for about 6 weeks) before both tests so the results are accurate.

Tests that may be done

• Blood test for antibodies (tTG-IgA and total IgA) — this is the first step
• If blood test is positive, a gastroscopy (a thin, flexible tube with a camera) is done to take a biopsy (a tiny piece of tissue) from the small intestine
• Genetic test (HLA typing) may be used in some cases, but it is not a routine test

What to expect at your appointment

Your doctor will ask about your symptoms and family history. If the blood test is positive, you will be referred to a specialist (gastroenterologist) for an endoscopy. This is usually done under sedation, meaning you will be relaxed and feel no pain. The whole process takes a few weeks. After diagnosis, you will be advised to start a strict gluten-free diet and work with a dietitian.

Treatment

The only treatment for coeliac disease is a strict, lifelong gluten-free diet. This means avoiding all foods and drinks that contain wheat, barley, and rye. Even small amounts of gluten can cause symptoms and damage to your intestine. A dietitian can help you learn what you can eat and how to avoid hidden gluten.

Self-care at home

• Learn to read food labels carefully — look for 'gluten-free' certification
• Avoid cross-contamination (e.g., use separate utensils, toaster, and cutting boards for gluten-free foods)
• Look for naturally gluten-free foods like fruits, vegetables, meat, fish, eggs, dairy, rice, potatoes, and corn
• Choose gluten-free grains such as quinoa, buckwheat, and gluten-free oats
• Talk to your doctor about vitamin supplements (such as iron, B12, vitamin D, and folate) if you have deficiencies

Medical treatments

There are no medications that can treat coeliac disease itself. However, if you have complications like severe anaemia or osteoporosis, your doctor may prescribe specific supplements or treatments to manage those problems. Some people may need vaccines (like the pneumococcal vaccine) if their spleen function is affected. Always consult your healthcare team before taking any supplements.

When is surgery considered?

Surgery is not a treatment for coeliac disease. In very rare cases, if a person develops a serious complication like intestinal lymphoma, surgery may be needed to remove affected parts of the intestine. This is extremely uncommon.

Living with this condition

Living with coeliac disease means being careful about everything you eat and drink. You will need to check labels on all packaged foods, ask about ingredients when eating out, and be mindful of cross-contamination at home and in restaurants. With practice, it becomes second nature. Many people find they feel much better on the gluten-free diet, with more energy and fewer symptoms.

Lifestyle tips

• Always carry gluten-free snacks when traveling or going out
• Tell restaurant staff about your condition clearly
• Join a local support group or online community to share tips and recipes
• Plan ahead for social events, parties, and holidays
• Keep a food diary to track symptoms and identify any hidden gluten

Diet and exercise

A gluten-free diet can be nutritious and balanced. Focus on whole, naturally gluten-free foods like fruits, vegetables, lean proteins, and gluten-free grains. A dietitian can help you avoid nutritional gaps. Exercise is good for overall health — start slowly if you have been feeling weak, and increase as you feel stronger.

Mental health and emotional wellbeing

Adjusting to a gluten-free diet can be challenging emotionally. You may feel isolated at social events, frustrated by the constant vigilance, or worried about accidental exposure. It is normal to feel anxious or down. Talk to your healthcare team about your feelings, and consider joining a support group. Many people find that their mood improves once their physical symptoms are under control.

Prevention

There is no known way to prevent coeliac disease because it is strongly linked to genetics. However, when diagnosed, following a strict gluten-free diet can prevent complications and improve quality of life.

Screening programmes

Screening (testing people without symptoms) is not routinely recommended for the general public. However, if you have a close family member (parent, sibling, child) with coeliac disease, you may be at higher risk. Talk to your doctor about whether you should be tested, especially if you have any symptoms or other autoimmune conditions.

Complications

If left untreated

• Osteoporosis (weak, brittle bones)
• Iron-deficiency anaemia (low red blood cells causing fatigue and weakness)
• Vitamin and mineral deficiencies (such as B12, folate, vitamin D)
• Infertility or recurrent miscarriages
• Dermatitis herpetiformis (itchy skin rash)
• Increased risk of small bowel cancer (very rare)
• Neurological problems (like numbness in hands and feet, balance issues) — uncommon

Long-term outlook

With a strict gluten-free diet, most people with coeliac disease lead healthy, normal lives. The intestine heals over time, symptoms disappear, and the risk of complications drops dramatically. It takes patience and practice to adjust to the diet, but many people feel much better after diagnosis. Life expectancy is normal with proper management.

Find support

International organisations

• Coeliac UK
• Celiac Disease Foundation (USA)

Local organisations

• Your local health service or GP practice · Contact your local health service for support groups and dietitian referrals.

Helplines

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