Coeliac Disease Is Not An Intolerance

Faiza Zahir
May 17, 2023
2 min read

Updated: Oct 31, 2023

Faiza Zahir, Content Writer at Grace Writes

Written by: Faiza Zahir (Content Writer)

Grace Pountney, Editor-in-Chief at Grace Writes

Edited by: Grace Pountney (Editor-in-Chief)

Step into science with Science Snapshot, a Bio Brigade blog. Find out about interesting science, health, and diseases. We spotlight individual stories, increase awareness of rare diseases, and answer your Science Suspicions!

Coeliac Awareness Week - 15th to 21st May 2023

Coeliac UK's campaign 'coeliac disease is different for everyone' for Coeliac Awareness Week 2023.

In light of Coeliac Awareness Week 2023, we are publishing several articles to raise awareness of the science behind coeliac disease and to shed light on the real-life stories of individuals negatively affected by gluten. Head to the Coeliac UK website for more information about Coeliac Awareness Week 2023, and to find out more about their campaign.

What is Coeliac Disease?

Coeliac disease is an autoimmune disease.

When gluten, a protein found in certain foods, is eaten, the immune system thinks it is a foreign invader and attacks the body's own tissue. This can lead to damage of the gut (small intestines), subsequently preventing the body from absorbing enough nutrients.

Coeliac disease is hereditary, meaning it runs in families.

It is unclear why some people develop coeliac disease or why symptoms, and their severity, differ, but family history, environmental factors, and other health conditions may contribute.

Close relatives of people with coeliac have a higher chance of developing the disease. If someone has a first-degree relative (for example, a parent or sibling) who suffers from coeliac disease, they have a 1 in 10 risk of developing the disease. Some people are carriers but do not suffer from the disease.

If not managed, coeliac disease can lead to cancer.

If people with coeliac disease do not refrain from eating gluten, whilst very rare, this can lead to cancer. Cancers associated with coeliac disease include small bowel cancer, small bowel lymphoma, and Hodgkin lymphoma.

What is Gluten?

Gluten is a protein found in food and drink containing wheat, barley, or rye.

Which food and drink contain gluten?

Gluten-containing foods include:

Flour
Bread
Cereals
Pasta
Chips
Biscuits
Baked-goods e.g. cakes
Sausages
Some crisps
Semolina
Couscous
Gravy
Some chocolates
Most processed foods

Gluten-containing drinks include:

Beer
Lager
Ale

Gluten-contaminated food and drinks include:

Oats
Oat milk

Though naturally gluten-free, in some cases oats may become contaminated in production with wheat, barley, or rye.

Which food and drink are gluten-free?

There are many naturally gluten-free foods and drinks, and alternative ingredients can be used to make gluten-free foods. Fortunately, most gluten-containing foods are now widely available as gluten-free options. Before eating, is important that people with coeliac disease always check the ingredients do not include gluten.

Naturally gluten-free foods include:

Fruit
Vegetables
Dairy products e.g. butter, margarine, & eggs
Legumes e.g. beans, seeds, & lentils
Nuts
Meat
Fish
Rice
Quinoa
Corn flour
Corn meal

What are The Symptoms of Coeliac Disease?

There is a wide range of symptoms of coeliac disease. One or more of these symptoms are experienced upon consumption of gluten.

Symptoms, and their severity, vary between cases. For example, some individuals may not experience digestive symptoms.

Digestive symptoms may include:

Diarrhoea
Constipation
Stomach aches
Bloating
Flatulence (passing gas)
Indigestion

Other symptoms:

Tiredness (failure to absorb enough nutrients from food and drink)
Weight loss (unintentional)
Itchy rash
Mouth ulcers (severe or persistent)
Infertility (problems getting pregnant)
Nerve damage
Coordination, balance, and speech disorders
Slow growth in children
Delayed puberty

How is Coeliac Disease Diagnosed?

Individuals may think they have coeliac disease if they experience any of the symptoms above, or know a family member who has coeliac disease. In either of these cases, it is important to see a doctor, who will refer you for appropriate tests, if necessary.

Diagnosis Pathway

Diagnosis Pathway in the UK:

GP Appointment

GP will ask questions about symptoms and family history of coeliac disease. If they think it could be coeliac disease they will refer the individual for a blood test and endoscopy.

2. Blood Tests

A coeliac blood test tests for coeliac disease antibodies. If your test comes back positive for coeliac you will be referred for an endoscopy and biopsy.

Super Science: Coeliac Blood Tests

The coeliac blood tests are called the Tissue Transglutaminase Immunoglobulin-A (tTG-IgA) test and the Total Immunoglobulin A (IgA) test.

IgA is an antibody* that plays a role in immune function

*Antibodies are proteins that recognise and destroy germs when they enter the body.

tTG is an enzyme* in the intestines

*Enzymes are proteins that speed up reactions in the body.

When an individual with coeliac disease consumes gluten IgA attacks tTG.

Some people with coeliac disease do not make the usual coeliac disease antibodies. This is called IgA deficiency. IgA deficiency is most commonly associated with autoimmune diseases; specifically coeliac disease.

3. Endoscopy & Biopsy

An endoscopy is a test where a thin, flexible tube with a camera on the end is passed into your mouth, down your throat and into your gut (small intestine). The endoscopist will look at your small intestine and record any visual observations. They will also take samples of the lining of your small intestine (biopsy). The sample will then be examined under a microscope for signs of coeliac disease. Before the procedure, the individual can often opt for a sedative (to relax the patient) or local anaesthetic (to numb the throat). The individual can check the options available with their healthcare provider.

Super Science: Coeliac Biopsy

People with coeliac disease have damage to the lining of their small intestine. The damage will be classified according to the Marsh classification scale:

Marsh 0: No damage to the small intestine lining, so the individual is unlikely to have coeliac disease.
Marsh 1: Increased number of lymphocytes (small white blood cells part of the body's immune system) but normal villi (hair- or finger-like projections that line the small intestine) length.
Marsh 2: Increased number of lymphocytes, larger-than-normal depressions in intestine lining, but normal villi length.
Marsh 3: More lymphocytes than normal, deep depressions, and somewhat flattened villi (villus atrophy).
Marsh 4: More lymphocytes than normal, very shrunken depressions, and completely flattened villi (villus atrophy).

4. Confirmation & Dietician Referral

If the biopsy comes back positive for coeliac, the coeliac disease diagnosis will be confirmed via letter (physical or online) or phone call. The individual will also receive a referral to a dietician who will offer guidance to the individual on how to manage their gluten-free diet long-term.

How is Coeliac Disease Treated and Managed?

The basis of treatment for coeliac disease is to remove gluten from the individual's diet completely.
Complete refrainment from gluten can reverse the negative effects on the small intestines and the risk of developing the types of cancer associated with coeliac disease becomes the same as that of the general population.

Science Suspicions

Each issue, we answer your science questions!

Is coeliac disease an intolerance or allergy?

Short answer: No!

Coeliac disease is an autoimmune disease.

The smallest amount of gluten can cause gut damage for people with coeliac disease. They cannot build a tolerance to gluten and it is a lifelong condition.

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