Although there is no cure for coeliac disease, following a strict gluten-free diet can minimise symptoms and development of serious complications.
In New Zealand, coeliac disease may affect 1 in 100 of the general population. However, the rate may be higher because many of these people will be undiagnosed or their condition incorrectly diagnosed as irritable bowel syndrome.
People who have a family member with coeliac disease are at increased risk of developing the condition. Down’s syndrome is also associated with an increased risk of coeliac disease.
A major life event such as pregnancy, severe emotional stress, surgery or exposure to a particular virus may activate the condition in certain individuals.
Individuals with other autoimmune conditions, such as rheumatoid arthritis, diabetes mellitus, and autoimmune thyroid disease, have a higher incidence of coeliac disease.
The average age of diagnosis of coeliac disease is approximately 40 years but it can occur at any age, including during early childhood. Often the onset of the condition occurs over a long period of time and goes relatively unnoticed.
Signs and symptomsIn children, the symptoms of coeliac disease tend to be more dramatic than in adults and usually appear soon after the introduction of cereal into the diet. Weight loss, diarrhoea, a swollen abdomen, and irritability may become obvious.
Symptoms of coeliac disease may include some, or all, of the following:
- Weight loss
- Indigestion, abdominal pain, bloating and flatulence. This may be general or associated with digestion of particular foods
- Gastrointestinal changes such as bulky fatty bowel motions (stools), sometimes pale and bad smelling
- Abdominal pain
- Diarrhoea or constipation
- Nausea and vomiting
- Anaemia (usually resulting from iron deficiency)
- Folate and vitamin B12 deficiencies
- Fatigue and generalised weakness
- Muscle cramps due to low calcium levels
- Blistering, itchy or painful rash – particularly about the knees, elbows, buttocks and back (dermatitis herpetiformis).
Mainly due the ability to absorb nutrients, children with coeliac disease may also display the following symptoms:
- Poor weight and height gains
- Delayed puberty
- Poor concentration and learning disabilities
- Poor muscle co-ordination and seizures.
The doctor will take note of the symptoms that the person has been experiencing and whether there is a family history of coeliac disease. Any unexplained deficiencies such as low iron or folate levels in the blood (causing anaemia) may alert the doctor to the possibility of an absorption disorder. A referral to a doctor specialising in digestive system disorders (a gastroenterologist) may then be made.
If coeliac disease is suspected, the person may have blood taken to test for specific antibodies that, if present at elevated levels, may indicate coeliac disease
Small bowel biopsy:
In New Zealand, the test most commonly used to diagnose coeliac disease involves taking a small tissue sample from the small bowel (biopsy) during a procedure called a gastroscopy. This involves a small flexible tube called an endoscope being passed down the person’s throat and into the small intestine. The endoscope contains a special camera that allows the specialist to view the inside lining of the small intestine on a television monitor and enables the removal of a small piece of tissue that is sent to a laboratory for viewing under a high-powered microscope.
Studies suggest that when gluten is withdrawn from the diet the bowel lining will be close to normal in around three months. Eating gluten again can result in severe damage to the bowel in as little as three weeks.
If coeliac disease is not effectively treated with a strict gluten-free diet, potentially serious long-term complications can occur. These include:
- Malnutrition (damage to the small bowel reduces its ability to absorb nutrients)
- Slow growth and short stature in children due to malnutrition
- An increased risk of developing certain types of cancer, including small bowel cancer
- Osteoporosis (low bone density due to calcium and vitamin D deficiency)
- Nervous system disorders such as irritability, depression , nerve damage (neuropathy), and seizures
- Missed menstrual periods
- Reduced fertility along with risks to the foetus.
Strategies for dietary management
The following guidelines will help a person with coeliac disease maintain good health:
- Never eat foods known to contain gluten
- Never eat foods with unknown ingredients as they may contain gluten
- Plan meals ahead of time, and keep gluten-free snacks available
- Many "fast foods" contain gluten so should not be eaten
- If eating out, use the internet to find restaurants that have gluten-free options
- Educate friends and family about the condition and gluten-free foods, so that meal invitations don’t become difficult.
Gluten-free food suppliers:
There are many suppliers of gluten-free food products and gluten-free food is increasingly common on supermarket shelves.
Further information and support
Coeliac New Zealand provides information and support for people who have coeliac disease. Their website contains information about the condition, treatments, gluten-free foods, shopping, and dining guides, and many other resources.
Coeliac New Zealand
Phone: (09) 820 5157
Coeliac New Zealand (Date not stated). What is coeliac disease (Web Page). Auckland: Coeliac New Zealand Inc. https://coeliac.org.nz/what-is-coeliac-disease-2/ [Accessed: 10/10/19]
Coeliac UK (2017). Oats (PDF). High Wycombe, Buckinghamshire: Coeliac UK. https://www.coeliac.org.uk/document-library/143-oats/?return=/information-and-support/living-gluten-free/the-gluten-free-diet/about-gluten/oats/
KidsHealth (2019). Coeliac disease (Web Page). Auckland: Starship Foundation and Paediatric Society of New Zealand. https://www.kidshealth.org.nz/coeliac-disease [Accessed: 10/10/19]
Lebwohl B., Sanders D.S., Green P.H.R. (2018). Coeliac disease. Lancet. 2018;391(10115):70-81.
Mayo Clinic (2019). Celiac disease (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220 [Accessed: 10/10/19]
NHS (2016). Coeliac disease (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/coeliac-disease/ [Accessed: 10/10/19]
Coeliac New Zealand. Coeliac Disease vs. Gluten Intolerance (Dr Jason Tye-Din). https://coeliac.org.nz/coeliac-disease-vs-gluten-intolerance-dr-jason-tye-din/ [Accessed 4/3/20]
Last Reviewed – March 2020