Coeliac disease

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who have coeliac disease, or who would like information about it.

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

People who have coeliac disease have an intolerance towards gluten - a protein found in certain foods, such as bread and pasta.

About coeliac disease

In the UK, around one in 300 people are thought to have coeliac disease, but many who have it haven't been diagnosed. Coeliac disease affects three times 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 containing 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 your food properly. Gluten is harmless to people who don't have coeliac disease.

People who have coeliac disease, which is an autoimmune condition, often develop an associated condition - for example, Sjogren's syndrome, type I diabetes, or Addison's disease.

Symptoms of coeliac disease

The symptoms of coeliac disease can range from mild to severe and may be similar to conditions such as irritable bowel syndrome and Crohn's disease. If you have coeliac disease, you may have:

• diarrhoea or constipation
• nausea and vomiting
• a bloated abdomen (tummy)
• excessive wind
• pain or cramps in your abdomen
• sudden or unexplained weight loss

You may also have symptoms unrelated to your digestive system, such as: losing your hair (alopecia); mouth ulcers; a skin rash (dermatitis herpetiformis); feeling tired and/or getting headaches.

Young children with coeliac disease may have muscle wasting in their arms and legs, be irritable and appear pale and unhappy.

Although not necessarily a result of coeliac disease, if you have any of these symptoms you should visit your GP.

Complications of coeliac disease

If it's left untreated, coeliac disease 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 - these are conditions in which your bones become weakened and are more likely to break
• an increased risk of developing cancer of your small bowel

If you have coeliac disease, sticking to a gluten-free diet will reduce your risk of developing these complications.

Causes of coeliac disease

The symptoms of coeliac disease are caused by your body reacting to gluten, which is found in foods that contain wheat, barley and rye - such as bread and pasta. Natural oats don't contain gluten, but some oat-based cereals do and may also give you symptoms.

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 reasons why some people may develop coeliac disease are not fully understood. However, coeliac disease 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.

Diagnosis of coeliac disease

Your GP will examine you and ask about your symptoms. He or she may ask you to have a blood test to look for antibodies against gluten. If the tests show you have the antibodies, you will be referred to a gastroenterologist (a doctor who specialises conditions that affect the digestive system) for an intestinal biopsy. In an intestinal biopsy, a narrow, flexible, tube-like telescopic camera called an endoscope is passed down your oesophagus (the pipe that goes from your mouth to your stomach) to take a small sample of the lining of your bowel. The tissue is then sent to a laboratory for testing.

Treatment of coeliac disease

If you eat a diet which doesn't include gluten (gluten-free) you won't develop the symptoms of coeliac disease. The treatment is, therefore, to avoid foods with gluten in them. You may find your symptoms disappear in as little as two weeks after cutting gluten out completely. Sticking to a gluten-free diet will also help reduce your risk of developing other, closely related, long-term diseases such as osteoporosis.

A dietitian will help you plan your gluten-free diet. If you have just been diagnosed with coeliac disease, you may be advised to take some vitamin and mineral supplements until you have settled in to your new diet.

Gluten is found in all foods that are made using wheat, barley or rye. As a general guide, you shouldn'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 tell you whether the food you're ordering is gluten free or not, you may have to ask. If in doubt, you shouldn't eat something you're unsure about.

Prevention of conditions associated with coeliac disease

Osteoporosis

If you're diagnosed with coeliac disease, your GP may ask you to have a dual x-ray absorptiometry (DEXA) scan to check the density of your bones. The scan can help look for signs of fragile bones and help assess your risk of developing fractures. You will need to have this scan again if you have a fracture at any point during your life, but especially when you reach the menopause if you are a woman, or at 55 if you are a man. 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 on DEXA scans or osteoporosis and how to prevent it, please see Related topics.

Infections

Coeliac disease can sometimes affect your immune system, so you are less able to fight infections. Your GP may suggest you have vaccinations against influenza, pneumococcus and haemophilus influenza type B. Also, if you travel to areas where there are tropical diseases such as malaria, you may need to take extra care to prevent yourself from catching an infection.

Living with coeliac disease

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

Visiting a dietitian to discuss your eating habits can help you control and stick to your gluten-free diet.

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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.