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Coeliac disease

Coeliac disease is a condition of the small bowel (intestine) that can cause serious illness if it's left untreated for a long time.

Gluten, found in foods such as bread, causes damage to the lining of the small bowel in susceptible people, causing coeliac disease.

  • About coeliac disease
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Prevention of conditions associated with coeliac disease
  • Living with coeliac disease
  • Further information
  • Sources
  • Related topics

About coeliac disease

Coeliac disease affects the small bowel. The lining of the small bowel is made up of finger-like projections called villi. If you have coeliac disease and eat food containing the protein gluten, the villi become damaged and inflamed. This damage stops your small bowel absorbing food properly so the normal levels of nutrients and minerals aren't taken into the body.

Up to one in 100 people may have coeliac disease in the UK. Many people who have coeliac disease have not been diagnosed. Coeliac disease affects three times as many women as men and can occur at any age.

Gluten is harmless in people without coeliac disease.

Symptoms

The symptoms of coeliac disease can range from mild to severe and include the following:

  • tiredness
  • diarrhoea
  • feeling bloated
  • pain or cramps in the abdomen (tummy)
  • wind
  • weight loss
  • constipation
  • mouth ulcers
  • sore tongue and mouth
  • problems with digestion
  • anxiety
  • depression
  • anaemia - when there aren't enough blood cells in the body
  • muscle loss
  • infertility
  • brain disorders

Children may vomit, lose their appetite, lose hair, not grow as expected and appear pale and unhappy. Symptoms are similar to conditions such as irritable bowel syndrome, wheat intolerance and stress.

There are a number of disorders that are linked to coeliac disease too. You may have one of the following conditions and also have coeliac disease:

  • type I diabetes
  • osteoporosis
  • thyroid disease
  • epilepsy
  • primary biliary cirrhosis
  • dermatitis herpetiformis
  • Sjogren's syndrome
  • immunoglobulin A deficiency

Complications

Untreated coeliac disease may cause:

  • reduced growth in children
  • an increased risk of developing osteoporosis or osteopenia - which are conditions where your bones are weakened and are more likely to break
  • an increased risk of developing cancer of the small bowel

Sticking to a gluten-free diet will reduce the chance of these complications occurring.

Causes

Coeliac disease is caused by your body reacting to proteins in wheat, rye and barley. Natural oats don't cause a reaction, but some oat-based cereals may contain small amounts of gluten and cause symptoms.

Coeliac disease may be inherited. One in 10 people who have coeliac disease have a brother, sister or mother who has the condition too. If you have coeliac disease and members of your immediate family haven't been tested and have symptoms, they may decide to take a test to find out if they also have coeliac disease.

Diagnosis

Your GP will examine you and ask about your symptoms. He or she may take blood tests. If the tests indicate that you may have coeliac disease, you will be referred to a gastroenterologist.

After a positive blood test for coeliac disease you will usually need an intestinal biopsy to confirm that you have coeliac disease. This is when a small sample of the lining of the bowel is taken using an endoscope, which is a narrow, flexible tube containing a camera. This is passed through your mouth to reach your small bowel. The tissue is then sent to a laboratory for testing.


Treatment

Coeliac disease is easy to treat: a diet which doesn't include gluten (gluten-free) is effectively a cure for coeliac disease. You may need to take some vitamin and mineral supplements short-term to ensure you are getting enough nutrients. A dietician will help you plan a gluten-free diet. As a general guide, you will need to avoid bread, pastry, cakes, pasta, pizza bases, biscuits, most cereals, beer, and processed foods such as sausages, soups and sauces.

You can eat gluten-free products, such as gluten-free bread, to replace the ones you can't eat to ensure you get a balanced diet. Foods that are made from maize don't naturally contain gluten and some products are labelled as gluten-free. You can buy these products in supermarkets and health food shops. Some may be available on prescription.

It may not always be straightforward, as manufacturers are not required by law to tell you how much gluten is in a product on the food label but it may be in the ingredients list. If in doubt you shouldn't eat something if you are unsure. You can though contact a manufacturer to check. If you are in a restaurant ask whether the food you are ordering is gluten-free if it doesn't tell you on the menu. Once you start to check the gluten content of foods you will get to know which you can eat.

Prevention of conditions associated with coeliac disease

Osteoporosis

If you are diagnosed with coeliac disease you should also have a DEXA scan. This is to check the density of your bones. You should also have this scan again when you reach the menopause if you are a woman, or at 55 if you are a man. If you have a fragility fracture, which is linked to osteoporosis, at any point during your life you should have a DEXA scan.

For more information on DEXA scans or osteoporosis and how to prevent it, please see Related topics.

Infections

If you have coeliac disease your immune system may be less able to fight infections because your spleen can shrink. If you travel to areas where there are tropical diseases you are more at risk. You may also decide to have vaccinations against influenza, particularly pneumococcus and haemophilus influenza type B.

Living with coeliac disease

You will need regular check-ups to monitor your progress while you have coeliac disease. This is often just done by your GP, but sometimes it will be done by your gastroenterologist.

Further visits to a health professional to discuss your diet can help you control and regulate what you are eating. You may need blood tests to monitor nutrient levels and to check that you are no longer producing antibodies that can continue to damage the small bowel.

Charities and patient groups which focus on coeliac disease can be an invaluable source of support and advice to help you adjust to your new diet.


Further information

Coeliac UK

Sources

  • Coeliac disease. Coeliac UK. www.coeliac.org.uk, accessed 7 November 2007
  • Gluten free. Food Standards Agency. www.eatwell.gov.uk, accessed 9 November 2007
  • Guidelines for the management and diagnosis of coeliac disease in adults. Clinical Resource Efficiency Support Team (CREST). May 2006. www.crestni.org.uk
  • Information about coeliac disease. CORE charity. 06/05. www.corecharity.org.uk, accessed 7 November 2007
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 454-455
  • The management of adults with coeliac disease in primary care. Primary Care Society for Gastroenterology. May 2006. www.pcsg.org.uk

Related topics

DEXA scan

Osteoporosis