Coeliac disease, also known as celiac disease, is a common bowel condition that is caused by intolerance to a protein called gluten. Gluten is found in wheat, rye and barley, which are often used to make foods such as bread, pasta and biscuits.

What causes coeliac disease?

The exact cause of coeliac disease is unknown. However, the condition can be inherited (run in families). Although it is linked to certain foods, coeliac disease is not a food allergy. It is an autoimmune condition, which means that it occurs as a result of the body’s immune system attacking gluten in the digestive system.

In people with coeliac disease, their immune system mistakes gluten as being harmful and attacks it, damaging the lining of the intestines (gut) so that it cannot absorb food properly. This leads to symptoms such as diarrhoea, weight loss and stomach pain.

Who gets coeliac disease?

Coeliac disease affects approximately one in 100 people in the UK. However, some people with the condition may have few or no symptoms. Many people may also have the condition but be unaware of it. Anyone can develop coeliac disease at any age, including babies and children, although it is most common among people aged 40 to 50.

There is no cure for coeliac disease, but the symptoms can be kept under control by eating a strict gluten-free diet. However, coeliac disease that is untreated or undiagnosed can cause several different complications.

Symptoms of coeliac disease

The symptoms of coeliac disease vary from person to person, and the condition affects babies and children differently to the way in which it affects adults. Some people who have coeliac disease may never develop symptoms. The various symptoms of coeliac disease in babies, children and adults are described below.

Symptoms of coeliac disease in babies

If your baby has coeliac disease, the symptoms will first appear soon after foods containing gluten are introduced into their diet, such as cereals and bread. Your baby’s symptoms may include:

• bulky and pale stools (faeces),
• smelly diarrhoea,
• vomiting,
• a swollen stomach, and
• failure to grow and gain weight.

Symptoms of coeliac disease in children

The symptoms of coeliac disease in children are similar to those in babies with the condition. If your child has coeliac disease, they may have:

• poor growth,
• pale, smelly, oily stools (faeces) that may be difficult to flush away,
• diarrhoea, and
• anaemia (tiredness, breathlessness and an irregular heartbeat, caused by a lack of iron in the blood).

Your child may develop anaemia because they cannot absorb enough vitamins and minerals, such as iron, from the food they eat. This is due to the damage in their digestive system caused by gluten intolerance.

Symptoms of coeliac disease in adults

If you have coeliac disease, your symptoms may include:

• stomach pain (which may come and go),
• excess flatulence (breaking wind),
• feeling bloated,
• diarrhoea,
• tiredness or weakness,
• mouth ulcers,
• weight loss, and
• anaemia (tiredness, breathlessness and an irregular heartbeat, caused by a lack of iron in the blood).

Due to the damage to your digestive system caused by gluten, you may develop anaemia alongside coeliac disease. This damage means that you cannot absorb enough vitamins and minerals, such as iron, from your food.

Dermatitis herpetiformis

Although it is not actually a symptom of coeliac disease, if you have an intolerance to gluten you may also develop a type of skin rash known as dermatitis herpetiformis.

If you have dermatitis herpetiformis, you will have an itchy, stinging rash, with blisters that may burst when you scratch them. The rash usually appears on your elbows, knees and buttocks, although it can appear anywhere on your body.

Causes of coeliac disease

Coeliac disease is caused by an intolerance to gluten, a protein that is found in foods such as bread, pasta, cereals and biscuits. Some people with the condition find that eating oats can also trigger their symptoms.

If you have coeliac disease, any gluten that you eat is attacked by your immune system when it reaches your intestines (gut). This happens because coeliac disease is an autoimmune condition, in which your immune system mistakes gluten for a harmful substance and produces antibodies against it. Antibodies usually fight off harmful foreign bodies, such as bacteria and viruses.

When the antibodies attack gluten, they can also damage the lining of your gut, causing inflammation. Normally, the surface of the gut lining is covered with millions of tiny tube-shaped growths called villi, which increase the surface area of your gut, helping it to digest food more effectively. However, in coeliac disease, the damage and inflammation to the lining of your gut flattens the villi, reducing their ability to aid digestion.

As a result of this, your gut can no longer digest all of the nutrients that you need from the food you eat. This leads to the symptoms of coeliac disease, including diarrhoea and weight loss.

Why does coeliac disease occur?

The exact reason why coeliac disease occurs is not fully understood. In some cases, it may not be possible to identify a cause at all. It is possible to develop an intolerance to gluten at any point in your life, for no apparent reason.

However, several possible causes of coeliac disease have been identified and are outlined below.

Family history:

Coeliac disease can be inherited and often runs in families. If you have a close relative with the condition, such as a parent, sibling (brother or sister) or child, you have an increased risk of also developing it. This increased risk is approximately one in 10, compared with one in 100 for those who do not have a close relative with coeliac disease.

Other conditions:

You are more likely to develop coeliac disease if you have certain conditions, including type 1 diabetes (insulin-dependent) or an under-active thyroid (hypothyroidism).

As with coeliac disease, this may be because these conditions are also caused by an autoimmune reaction. Type 1 diabetes occurs when your immune system attacks cells in your pancreas that produce insulin, and hypothyroidism commonly occurs when your immune system targets your thyroid gland.

Coeliac disease is also more common among people who have osteoporosis (weak and brittle bones) or ulcerative colitis (inflammation and ulcers in the large intestine).

Stress or trauma:

In some cases, it is thought that coeliac disease may be brought on by severe stress, although the reason for this is unknown.

Similarly, you may have an increased risk of developing coeliac disease after a stressful event or a trauma on your body. For example, it is possible for people to develop coeliac disease after an infection or injury, after surgery or after pregnancy.

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