FacebookCoeliac disease diagnosis
Coeliac disease is an autoimmune disorder which can occur at any age and which can present with a wide range of symptoms. The condition is triggered by gluten, which is a protein contained in the cereal grains wheat, rye and barley. In people with coeliac disease, consuming gluten-containing foods leads to chronic inflammation of the small intestine.
Gut damage and nutritional deficiencies
The lining of the small intestine has millions of microscopic folds known as 'villi'. The villi enlarge the surface area of the small intestine to help the body absorb nutrients from food. When someone with coeliac disease eats gluten, an autoimmune reaction causes inflammation in the lining of the small bowel, this flattens the villi and means the body is unable to absorb as many nutrients from food. This can lead to nutrient deficiencies, particularly vitamin B12, iron or calcium. Untreated coeliac disease can also cause secondary conditions such as anaemia or osteoporosis.
Testing for coeliac disease
Your GP will be able to perform a simple blood test to look for the presence of coeliac-specific antibodies. If these are present, you will be referred to a gastroenterologist (a doctor who specialises in gut disorders) for further tests and possibly a biopsy of your small intestine, to confirm the diagnosis. Depending on your age and the nature of your symptoms, it may be possible for your gastroenterologist to diagnose coeliac disease without the need for a biopsy.
It is essential that you continue to follow a gluten-containing diet throughout the testing procedure, otherwise your results may not be accurate.
If coeliac disease is diagnosed, a strict life-long gluten-free diet will resolve your symptoms and allow your gut to heal. Your GP or gastroenterologist should refer you to a dietitian to support you through this process.
Other cereal diseases
If your test results show that you don’t have coeliac disease, but you still feel that your symptoms are triggered by eating gluten-containing foods, you may be suffering from an alternative gluten-related condition, for example:
- In individuals with a wheat allergy, the immune system reacts to the consumption of various wheat proteins. Symptoms may include a rash, wheezing and/ or bowel discomfort. Whilst these individuals have to follow a wheat-free diet, they can consume other gluten-containing cereals without any trouble. A blood test may be performed to rule out this condition.
- The symptoms of gluten sensitivity are similar to those of coeliac disease, however there is no damage caused to the gut. There is currently no available laboratory test to diagnose gluten sensitivity, therefore, if coeliac disease and wheat allergy have been ruled out as reasons for symptoms, a diagnosis of gluten sensitivity may be made, based on symptom improvement on a gluten-free diet.
If coeliac disease, gluten sensitivity and wheat allergy are ruled out, irritable bowel syndrome may also be considered as a potential cause for symptoms. Many people with IBS find that a low FODMAP diet (a diet that is low in fermentable carbohydrates) helps to resolve symptoms. Gluten-containing cereals such as wheat are one of the main contributors to FODMAP intake in the UK.
