Celiac Disease

Celiac disease is an autoimmune condition. This means the immune system, which normally defends the body against infection, mistakenly attacks the body's own tissue. In celiac disease, eating gluten triggers the immune system to damage the lining of the small intestine.

Gluten is a protein found in wheat, barley, and rye, and so in many everyday foods such as bread, pasta, cereals, and some processed products. When the gut lining is damaged, the body cannot absorb nutrients properly, which can lead to a range of symptoms and health problems.

Celiac disease is often confused with a wheat allergy or with general gluten intolerance, but it is different. A food allergy involves a rapid immune response that can affect breathing and the skin, while celiac disease is an autoimmune reaction that gradually damages the small intestine.

Some people have symptoms after eating gluten without having celiac disease or a wheat allergy, sometimes called non-coeliac gluten sensitivity. Celiac disease is specific: it can be identified with tests and causes measurable changes to the gut lining.

Symptoms vary widely. Many people have digestive symptoms such as diarrhoea, stomach pain, bloating, indigestion, or constipation. Others have symptoms outside the gut, including tiredness, unintentional weight loss, mouth ulcers, an itchy rash, and, in children, slowed growth.

Because celiac disease can interfere with nutrient absorption, it may also cause iron, vitamin B12, or folate deficiency, leading to anaemia. Some people have very few symptoms and are only diagnosed after tests done for another reason.

Celiac disease develops in people who have a genetic tendency to it, when their immune system reacts abnormally to gluten. It often runs in families, so close relatives of someone with the condition are at higher risk.

It is also more common in people with certain other autoimmune conditions, such as type 1 diabetes and autoimmune thyroid disease. It can be diagnosed at any age, from childhood through to later life.

Diagnosis usually begins with a blood test that looks for specific antibodies linked to the immune reaction to gluten. If this is positive, the diagnosis is normally confirmed with a biopsy, where small samples of the lining of the small intestine are taken during an endoscopy and examined.

It is very important to keep eating gluten-containing foods regularly until all tests are complete. Cutting out gluten beforehand can allow the gut to heal and may give a falsely normal result, making the condition harder to diagnose. Your doctor will advise you on this before testing.

There is no cure for celiac disease, but it can be managed very effectively with a strict, lifelong gluten-free diet. Removing gluten allows the gut lining to heal, relieves symptoms, and helps prevent long-term complications. Even small amounts of gluten can cause problems, so careful attention to food labels and cross-contamination is needed.

Support from a dietitian is valuable for learning which foods to avoid and how to maintain a balanced diet. Doctors may check for and treat nutrient deficiencies, monitor bone health, and arrange regular follow-up to make sure the condition is well controlled.

If celiac disease is not treated, ongoing damage to the gut can lead to poor absorption of nutrients, anaemia, and weakening of the bones (osteoporosis). It can also cause problems in pregnancy and, rarely, is linked to certain other conditions. This is why a strict gluten-free diet is so important even when symptoms are mild.

The outlook for people who follow a gluten-free diet is generally very good. The gut usually heals, symptoms improve, and the risk of complications falls. With good support and regular review, most people are able to manage the condition well and live a full, healthy life.