Many people with coeliac disease feel fine until gluten leaves their diet
Coeliac disease is an autoimmune reaction to gluten, the protein in wheat, barley and rye, and it affects somewhere between 1 in 200 and 1 in 50 people. Plenty of them go undiagnosed for years, partly because their symptoms are vague and partly because chronic low-grade illness can come to feel normal.
In genetically predisposed people, eating gluten inflames the small intestine and wears away its lining, so nutrients are poorly absorbed. Infections and other environmental factors are thought to play a part in who develops it. The condition usually starts before age 10 and is slightly more common in women than men. Because it acts throughout the body, it can reach organs well beyond the gut.
Doctors sort presentations into several types. The classic form, typically found in young children, shows up as diarrhoea, weight loss and poor growth. The non-classic form, more usual in adults, brings vague abdominal complaints plus problems elsewhere such as bone disease and anaemia. Common symptoms outside the gut include headaches, fatigue, brain fog and aching muscles or joints, and as the bowel is damaged, lactose intolerance can follow. Some people have no symptoms at all and are found only through screening, while others who believe they are symptom-free notice a difference only after changing their diet.
Diagnosis combines symptoms, blood tests and a biopsy of the small intestine. Anyone who has already stopped eating gluten may need to resume it before testing for the results to be reliable. Diagnoses have climbed as awareness and blood testing have spread, yet the disease is still considered underdiagnosed, and evidence does not currently support screening everyone who lacks symptoms. Potential coeliac disease describes positive blood tests without intestinal changes.
The only established treatment is lifelong avoidance of wheat, rye, barley and their derivatives. Symptoms can ease within days, and effects such as stunted growth may normalise. When symptoms persist for 6 to 12 months despite the diet, most cases turn out to have another cause; refractory disease, with intestinal damage continuing past 12 months, is a separate and rarer category. Older names for the condition include sprue and gluten-sensitive enteropathy.
Source: Coeliac disease
