Wednesday 18 September 2019

Coeliac disease not an allergy or intolerance

By Dr Michelle Cooper

Coeliac disease is a condition that causes inflammation within the lining of the small intestine. This inflammation subsequently means that food and nutrients cannot be readily absorbed by the body. Coeliac disease affects about 1 in 100 people in Ireland.

Coeliac disease is not a food allergy or intolerance, but an autoimmune disease. This means that the immune system, which normally protects the body from infections, mistakenly attacks itself.

The cause of coeliac disease is sensitivity to gluten. Gluten is found in everyday foods containing wheat, barley and rye, such as bread, pasta and biscuits. Some people with coeliac disease are also sensitive to oats. In people with coeliac disease, the body makes antibodies against gluten. These antibodies lead to inflammation developing in the lining of the small intestine.

Coeliac disease is most commonly diagnosed in people between the ages of 40 and 50 years. It is not known as to why the immune system may suddenly become sensitised to gluten. Coeliac disease often runs in families and is more common in people who have other autoimmune diseases.


Children: Symptoms may first develop soon after weaning when a baby starts eating solid foods containing gluten. As food is not being absorbed properly, stool may be pale and bulky and may also be smelly and difficult to flush away. Diarrhoea may even occur. The tummy may become swollen and repeated vomiting may occur. Symptoms, however, may not be entirely obvious. The first thing that may be noticed is poor growth.

Adults: Poor absorption of food may cause deficiencies of vitamins, iron, and other nutrients. Anaemia due to poor iron absorption is common. Other symptoms include abdominal pains, excess wind, bloating, diarrhoea and tiredness or weakness. Mouth ulcers may occur. You may lose weight due to poor absorption. However, most adults with coeliac disease do not lose weight and are not underweight.


If coeliac disease is suspected, a blood test to detect a certain antibody may be ordered by your doctor. It is important that gluten is being consumed for at least six weeks before the blood test. If positive, you may then be referred to a specialist for a confirmatory biopsy.


Gluten free diet: Gluten needs to be avoided for the rest of your life. The symptoms that patients suffer from usually go within a few weeks of omitting gluten from ones diet. Special gluten free flour, pasta, bread and other foods are widely available. There are many diet sheets with food alternatives and recipes available.

Vitamins: You may be advised to take certain vitamins, calcium and iron supplements for the first six months following diagnosis.

Immunisations: You may be advised to have the flu jab as well as the pneumococcal vaccine. This is because your spleen works less effectively, making you more vulnerable to infection.


People with coeliac disease can have an increased risk of developing osteoporosis, lymphoma and premature delivery if pregnant. There are also risks of developing other autoimmune related illnesses. The likelihood of developing these illnesses reduces when coeliac patients refrain from eating gluten.

Further information is available from the Coeliac Society of Ireland's website

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