Main
- Coeliac disease is an autoimmune reaction to gluten from wheat, rye and barley that damages the villi of the small intestine.
- Diagnosis and management are handled by a gastroenterologist, with the involvement of a dietitian, and in children — a paediatrician.
- Testing is carried out before giving up gluten: a diet in advance distorts blood tests for antibodies.
- The main method of management is a lifelong gluten-free diet, not a temporary restriction for a few weeks.
- Traces of gluten are found in sauces, seasonings, sausages and confectionery products.
What is coeliac disease
Coeliac disease is a persistent intolerance to gluten, in which the immune system damages the lining of the small intestine. This section explains what happens in the body, why the condition develops and who is affected by it more often.
What happens in the body
Gluten is a protein found in wheat, rye and barley and enters the body with ordinary food. In people with a hereditary predisposition, the immune system perceives this protein as foreign and begins to react to it. As a result of this reaction, the mucous membrane of the small intestine, where nutrients are absorbed, is damaged. Because of the damage to the intestinal villi, the body stops receiving enough proteins, fats, carbohydrates, vitamins and minerals. This gradually affects the functioning of various organs and systems, not just digestion. A person may notice changes in how they feel, but it is not always easy to link them to food. Therefore, if gluten intolerance is suspected, it is important not to remove it from the diet on your own before consulting a doctor.
Why it develops
- Hereditary predisposition: a tendency to react to gluten is passed down the family line, so the risk is higher in close relatives.
- Consumption of products containing gluten: without this protein entering the food, the disease does not occur, even if there is a genetic tendency.
- A previous intestinal infection: it can trigger the first reaction in a person who previously ate gluten without visible consequences.
- Severe stress: difficult life events sometimes coincide with the onset of manifestations, although by themselves they do not cause the disease.
- Pregnancy and childbirth: changes in the body during this period sometimes become the background against which the condition first makes itself known.
- Age of onset: the disease can manifest at any age, so the appearance of signs in an adult does not rule out such a cause.
Who is affected more often
Coeliac disease occurs in people of different ages, but it is more often detected in those whose close relatives already have such an intolerance. Hereditary predisposition increases the likelihood of a reaction to gluten, however, without the protein itself in the diet, the condition does not develop. In women, manifestations often first coincide with pregnancy or childbirth, when the body undergoes noticeable restructuring. A previous intestinal infection and severe stress can also be the trigger after which the first changes in how one feels appear. In children, the condition is often noticed during the period when foods with wheat, rye or barley are introduced into the diet. In adults, it can remain unnoticed for a long time, because the signs are mild and easily explained by other causes. Therefore, with a family history of gluten intolerance, it is worth discussing with a doctor the need for examination, without waiting for pronounced manifestations.
What symptoms can occur?
Coeliac disease can manifest in different ways, and it is not always easy to notice. Below is an outline of which signs occur, how to recognise them and when a visit to the doctor must not be postponed.
How it is noticed at the very beginning
At the beginning, coeliac disease often makes itself known through bloating and abdominal pain, which are easily put down to tiredness or an accidental slip in the diet. In some people, stools become irregular: chronic diarrhoea appears or, conversely, constipation without an obvious cause. Gradually weakness sets in, and the skin becomes pale, and this is already hard to explain by ordinary overwork. Weight falls on its own, although diet and activity levels remain the same. In children, parents notice that the child lags behind peers in growth. Sometimes the first complaint is an itchy rash on the skin, while digestion causes almost no trouble. If such signs persist for weeks, it is sensible not to wait, but to discuss them with a gastroenterologist.
Signs that occur most often
- Bloating and abdominal pain: the abdomen feels distended and pulls after eating, the discomfort persists for a long time and interferes with everyday activities.
- Chronic diarrhoea or constipation: stools change for a long time, become unpredictable and do not return to the usual rhythm.
- Unexplained weight loss: body weight drops, although the person eats as usual and has not changed their activity level.
- Pallor and weakness: the skin looks pale, tiredness comes on quickly, which was not there before.
- Growth retardation in children: the child grows more slowly than peers, and this is noticed by clothing and measurements.
- Itchy rash on the skin: itchy eruptions appear that respond poorly to ordinary skin care.
When to seek help urgently
Examinations and tests
Testing for coeliac disease helps confirm the condition, assess the extent of intestinal damage and rule out other causes of the symptoms. Below is an outline of which tests the doctor orders and what each of them shows.
How the examination begins
The examination begins with a conversation with the doctor and a physical examination, during which he asks in detail about the symptoms and how long they have been present. The doctor clarifies how the person's well-being changed after eating food containing wheat, rye or barley, and whether there have been similar cases among relatives. Separately, he asks about the use of any remedies and whether the person has already tried removing gluten from their diet. This is a fundamental point: if a gluten-free diet is started before the diagnosis is complete, the test results may be distorted. The doctor then orders a blood test for gluten antibodies to assess the body's reaction to this protein. The diagnosis is made based on the combination of signs, tests and examination results, not on a single indicator. Therefore, one should not change the diet on one's own before the doctor completes the examination and draws a conclusion.
What is ordered and what it shows
What to prepare for the appointment
- Discharge summaries: bring all recent medical documents, including conclusions from other specialists, so that the doctor can see the full picture.
- Test results: collect previous laboratory data, even if it was done long ago, this will help assess changes in the indicators.
- Food diary: write down which foods and at what time you ate, as well as when symptoms appeared after eating.
- List of symptoms: describe in order what has been bothering you and for how long, including changes in weight and well-being.
- Questions for the doctor: formulate in advance what you want to clarify about the examination and further steps, so as not to forget at the appointment.
Which doctor should I see?
This section explains which doctor to consult for coeliac disease, what happens at the first appointment and what areas of care it involves. It will help you choose a specialist and understand how follow-up is organised.
Which specialist manages this condition
Coeliac disease is managed by a gastroenterologist, and when necessary a dietitian and a paediatrician are also involved. The gastroenterologist assesses the condition of the intestinal mucosa and general well-being, prescribes the necessary tests and monitors the person from the moment of referral. The dietitian helps build a gluten-free diet so that nutrition remains complete and varied. The paediatrician manages children with this condition and monitors their growth and development. If there is no specialist gastroenterologist nearby, you can start with a physician or paediatrician: they will advise where to go next. At the first appointment, the doctor asks in detail about complaints, diet and how the person feels during the day. They also correct vitamin and mineral deficiencies, monitor the condition of the intestine and, if necessary, involve other specialists. It is worth writing down your questions and observations in advance so that you do not forget anything at the appointment.
What treatment consists of
- Gluten-free diet: strict lifelong exclusion of gluten from the diet, which allows the intestinal mucosa to recover and relieves symptoms.
- Replenishing vitamin and mineral deficiencies: the doctor assesses the lack of nutrients and helps correct it, because it affects well-being.
- Follow-up with a gastroenterologist: regular visits make it possible to track the condition of the intestine and notice changes in time.
- Dietitian consultations: the specialist helps select products and create a menu so that nutrition remains varied.
- Treatment of concomitant conditions: if necessary, the doctor involves other specialists so that care is complete.
What depends on the patient themselves
Regular follow-up and strict adherence to the diet largely determine how the person will feel. If gluten is completely excluded from the diet and no exceptions are made, the intestinal mucosa has the opportunity to recover. Missed doctor's visits make it difficult to assess the condition and may hide a lack of vitamins or minerals. The dietitian helps select products so that nutrition remains complete and does not turn into a set of restrictions. Keeping a food diary and recording complaints help the doctor understand more precisely what is happening between appointments. If new symptoms appear or well-being worsens, it is important to inform the specialist rather than wait for a scheduled visit. Calm and consistent following of recommendations gives the doctor more support for decisions. It is worth clarifying in advance how often you need to come for an appointment and which changes are important to track.
What helps prevent an exacerbation?
In coeliac disease, much depends on the everyday decisions of the person themselves and on how attentively they treat their condition. Below — about the habits that reduce the risk of an exacerbation, about what should be kept under control, and about regular visits to the doctor.
What is changed in habits
A lifelong exclusion of gluten remains the main condition under which the condition stays stable for many years. Even small amounts of gluten in food can trigger a reaction, so it is important to read the composition of products in the shop carefully. Traces of gluten are found in sauces, ready-made seasonings, sausage products and confectionery items, where they are hard to suspect. In the kitchen, it is worth keeping separate boards, knives and dishes so that crumbs of gluten-containing products do not get into the dish. When visiting others and in cafés, the habit of finding out in advance what the dish is made from and how it was processed helps. If a person keeps a food diary, they notice more quickly the connection between an accidental mistake in food and a worsening of how they feel. Such a diary should be shown to the doctor at an appointment, so that disputable situations can be sorted out together.
What should be kept under control
- Composition of products: checking labels before buying helps to notice gluten in time and avoid its accidental entry into the diet.
- How you feel: observing changes in the condition shows how the body responds to food and whether there are hidden disorders.
- Food diary: records of what was eaten during the day give the doctor a clear picture and help to sort out disputable cases.
- Family history: information about relatives with a confirmed disease suggests who needs to undergo examination earlier.
- Regular check-ups: planned visits to a specialist allow deviations to be noticed before they become noticeable to the person themselves.
How often to see the doctor
Regular check-ups with a specialist are needed even when the state of health seems quite good and nothing is troubling. In coeliac disease, the condition can change imperceptibly, and deviations in nutrition can accumulate gradually, without obvious signs. The doctor assesses how strictly the diet is followed and, if necessary, clarifies the recommendations on nutrition. At the appointment, it is worth telling about accidental mistakes in food, about changes in how you feel and about the difficulties the person has encountered. If there are relatives in the family with a confirmed disease, it also makes sense for them to undergo examination without waiting for complaints. The frequency of visits is determined by the doctor taking into account the condition and circumstances of each person. Such meetings should not be skipped: a calm state of health today does not cancel control in the future.
What is worth remembering
Coeliac disease is a condition in which the body reacts to gluten, and the discussion of it is worth concluding with a few takeaways. They help the reader understand what to do next and what to rely on in making a decision.
Key takeaways
Coeliac disease does not go away on its own and is not treated with temporary restrictions, so it is important for a person to accept it as a permanent feature of their body. Noticing coeliac disease can be difficult: the signs resemble other disorders, and sometimes remain mild for a long time. That is why, if coeliac disease is suspected, testing is carried out before the person removes gluten from their diet, otherwise the result may be unreliable. If coeliac disease is confirmed, the basis of care is lifelong avoidance of gluten, not a short diet for a few weeks. Even small indulgences can bring back unpleasant symptoms and gradually harm the body. With coeliac disease, it is important to be followed up by a specialist and to check one's condition from time to time, rather than relying only on how one feels. Approach coeliac disease calmly and consistently: it is a condition one can live with fully, if one does not put off a visit to the doctor and does not self-treat.
