Coeliac disease

Your health expert: Christina Merryfield, Bupa Senior Specialist Dietitian
Content editor review by Dr Kristina Routh, July 2022
Next review due July 2025

Coeliac disease is a condition where your body reacts to gluten. Gluten is a protein found in certain foods such as bread, cereals and pasta. The lining of your small bowel becomes damaged, causing a wide range of symptoms including diarrhoea, tummy cramps and bloating.  

You can get coeliac disease at any age. If you have it, you’ll need to follow a life-long, gluten-free diet. This stops the symptoms for most people. 

Coeliac disease illustration by Bupa UK

About coeliac disease

Coeliac disease isn’t the same as a food allergy or food sensitivity. It’s an autoimmune condition. This means your body’s immune system mistakenly attacks your own healthy tissue. If you have coeliac disease, your immune system mistakes gluten for something harmful. Gluten is a protein found in wheat, barley and rye.

When your immune system attacks gluten, it damages the lining of your small bowel (intestine). The lining of your small bowel is made up of tiny finger-like projections called villi. In coeliac disease, your villi become damaged and flattened. This stops your small bowel fully absorbing the nutrients in your food.

Causes of coeliac disease

Doctors aren’t yet sure what causes coeliac disease. It may run in families – 1 in 10 people who have coeliac disease have a sibling or parent who also has it. But having a relative with coeliac disease doesn’t necessarily mean that you’ll get it.

You’re more likely to get coeliac disease if you have another autoimmune condition, such as type 1 diabetes or autoimmune thyroid disease.

Symptoms of coeliac disease

Some people with coeliac disease get no symptoms. You may only find out you have the condition when your doctor checks you because you have other, related medical conditions.

The symptoms of coeliac disease symptoms vary widely. If you have coeliac disease, your symptoms may include:

  • diarrhoea – which may smell especially unpleasant
  • a bloated tummy (abdomen)
  • excessive wind
  • tummy cramps
  • unexplained weight loss
  • fatigue and feeling tired all the time

The symptoms of coeliac disease are similar to irritable bowel syndrome (IBS). So if you have IBS, your GP may test you for coeliac disease to see if this is causing your symptoms.

If you’re not absorbing your food properly, you may be short of vitamins and minerals. This can lead to you developing conditions such as anaemia and osteoporosis.

Young children with coeliac disease may find it difficult to gain weight. They may grow more slowly than other children. They may also be more irritable than usual.

Having these symptoms doesn’t necessarily mean you have coeliac disease. But it’s best to get things checked out by your GP.

Diagnosis of coeliac disease

Diagnosis of coeliac disease involves having:

  • a blood test to see if you might have the condition
  • a biopsy of the small intestine to establish whether or not you do have it


Blood test

When you see your GP, they’ll ask about your symptoms and your family’s medical history. If they think you might have coeliac disease, your GP will offer you a blood test. This will look for certain antibodies that are present in people with coeliac disease.

If the tests show that you have these antibodies, your GP will refer you to a gastroenterologist. This is a doctor who specialises in identifying and treating conditions that affect the digestive system.

If your blood test is negative but you keep having symptoms, your GP may still refer you.

Intestinal biopsy

Your gastroenterologist will probably suggest that you have a test called an intestinal biopsy. Your doctor will use a narrow, flexible, tube-like telescopic camera called an endoscope. They’ll pass this through your mouth down to your stomach and on to your small bowel. They’ll then take a small sample (biopsy) of the lining of your bowel.

The sample will be sent to a laboratory to look for damage to your bowel. Your doctor will explain the procedure to you, and discuss ways to make it as comfortable as possible. You can find out more about this type of procedure from our topic on gastroscopy.

Important information about eating gluten and testing

It’s very important that you’re still eating gluten when you have these tests. If you’ve already changed to a gluten-free diet, your tests may appear normal even if you have coeliac disease. Aim to eat some gluten in more than one meal every day for at least six weeks before you’re tested.

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Treatment of coeliac disease

The only treatment for coeliac disease is to follow a life-long, strict gluten-free diet. You may find your symptoms improve within a week or two once you’ve cut out gluten completely.

Your doctor will refer you to a specialist dietitian. They’ll offer you lots of support and practical help to help you manage your condition. They may suggest you contact the charity Coeliac UK, which can give you lots of practical advice. See our section ‘Other helpful websites’ for their contact details.

Gluten is found in foods made with wheat, barley or rye. So products such as bread, pastry, cakes, pasta, pizza bases and biscuits all contain gluten. Gluten is also found in foods where you may not expect it – for example, breakfast cereals and processed foods such as sausages, soups and sauces. Most beers also contain gluten. Oats may be contaminated with gluten, so you need to take care if you are using oats.

You’ll need to start checking the labels on foods. It should say if the product contains gluten, as well as giving a list of ingredients. Foods labelled ‘gluten-free’, ‘very low gluten’ or which have the Crossed Grain Symbol are generally safe for most people with coeliac disease to eat. After a while, you’ll get more familiar with what you can and can’t eat. You can find gluten-free bread, biscuits and pasta in most supermarkets or health food shops.

If you’re eating out and the menu doesn’t say whether or not the food contains gluten, just ask. If in doubt, it’s safer not to eat something you’re unsure about.

Understandably, many people find it hard to stick to a strict gluten-free diet. But it really is important for your health. Nine out of ten people with coeliac disease who stick to a gluten-free diet find that their symptoms go away.

If you have coeliac disease, your dietitian may advise you to take some vitamin and mineral supplements (such as calcium and vitamin D).

Eating gluten by accident

It can be difficult to follow a gluten-free diet and mistakes happen, especially when you’re just starting. If you eat gluten, you may get some symptoms a few hours after you eat. These could last for a few hours to several days. But everyone with coeliac disease is different and you may find you don’t have any symptoms at all. If you make the odd mistake, it’s unlikely to cause lasting damage to your bowel. But it’s important to always check what you’re eating and follow a gluten-free coeliac diet.

Regular health checks

Coeliac disease is a lifelong condition so you should be offered regular check-ups. These are usually once a year, and may be with your pharmacist, specialist nurse, dietitian or doctor.

At your check-up, they’ll ask you about any symptoms you have and how you’re getting on with your gluten-free diet. Children and teenagers may have their height measured to make sure they’re growing properly. You may need blood tests to check your health and to see if your body is absorbing enough nutrients.

Because of the risk of getting osteoporosis, from time to time your GP may recommend that you have a dual X-ray absorptiometry (DXA) scan. This checks the density of your bones. For more information, see our topic on osteoporosis.

Having coeliac disease can mean you’re less able to fight infections. Your GP will suggest you have the annual flu vaccine and the pneumococcal vaccine that protects against some types of pneumonia. If they recommend you have other vaccinations, they’ll explain why.

Complications of coeliac disease

Coeliac disease may lead to a range of potential health problems. But you can greatly reduce your risk of developing these complications if you stick to a gluten-free diet.

Complications of coeliac disease include the following:

  • Illness caused by lack of nutrients, including deficiency in iron (causing anaemia) and other vitamins or minerals.
  • Osteoporosis, where your bones become weakened and are more likely to break.
  • Reduced growth, and delayed puberty in children.
  • Reduced fertility in both men and women.
  • A skin problem called dermatitis herpetiformis, where itchy blisters form on your skin.
  • A small, increased risk of developing certain cancers of the digestive tract and some kinds of lymphoma.

Coeliac disease is an autoimmune disease. This means that it’s caused by your immune system mistakenly attacking your own tissues. In coeliac disease, this reaction happens when you eat a protein called gluten. Gluten is found in foods containing wheat, barley and rye. The reaction to eating gluten causes damage to the lining of your small intestine, which then can’t absorb nutrients properly.

The most common symptoms of coeliac disease are diarrhoea, tummy cramps, bloating and flatulence (passing excess wind). Other symptoms include unexplained weight loss and feeling very tired all the time. How severe the symptoms are can vary widely. Some people don’t get any symptoms at all.

If you have coeliac disease, you’ll need to make sure that you avoid all foods that contain gluten. This means anything containing wheat, barley or rye. Food labels should tell you if gluten is present so it’s important to get into the habit of reading these carefully. A dietitian can give you advice about what to eat, and you can get more information from the website of Coeliac UK (see our section ‘Other helpful websites’ for contact details).

Coeliac disease is usually diagnosed in a two-step process. First, you have a blood test to look for antibodies found in people with coeliac disease. If those are present, the diagnosis can be confirmed by having an intestinal biopsy. For more information, see our section on diagnosis.

It’s thought that 1 in 100 people have coeliac disease. There are probably lots of people who have the condition, but have never been diagnosed. It affects all age groups, including children and older people. People can develop coeliac disease at any time in their lives.

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