Coeliac Disease

Coeliac disease is an autoimmune condition where the immune system reacts to gluten (a protein found in wheat, barley and rye). This reaction damages the lining of the small bowel, reducing the body’s ability to absorb nutrients properly.

Symptoms can be digestive (such as diarrhoea and bloating) or non-digestive (such as fatigue or anaemia). Some people have very mild symptoms, and in others coeliac disease is only suspected after abnormal blood tests or complications.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to confirm the diagnosis and put a clear treatment and follow-up plan in place.

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Common symptoms of coeliac disease

Symptoms vary widely and may come and go. Common symptoms include:

Digestive symptoms

• Bloating, abdominal pain or discomfort
• Diarrhoea, loose stools, or constipation
• Excess wind
• Nausea or vomiting
• Unexplained weight loss

Non-digestive symptoms

• Tiredness and low energy
• Iron-deficiency anaemia (or low folate/B12)
• Mouth ulcers
• Headaches
• Bone or joint pain
• Skin symptoms (some people develop an itchy blistering rash called dermatitis herpetiformis)
• Fertility problems or recurrent miscarriage (in some cases)

Children may have poor growth, delayed puberty, abdominal distension, irritability, or unexplained weight loss.

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What causes coeliac disease?

Coeliac disease occurs when the immune system reacts abnormally to gluten. It is more common in people with a family history of coeliac disease or other autoimmune conditions (such as type 1 diabetes or autoimmune thyroid disease).

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis usually involves blood tests and often endoscopy with small bowel biopsies in adults.

Important: keep eating gluten during testing

Do not start a gluten-free diet before tests are complete, as this can make results inaccurate.

Blood tests (serology)

Typical testing includes:

• Total IgA and IgA tissue transglutaminase (tTG) as first-line tests
• If tTG is weakly positive, IgA endomysial antibody (EMA) may be used to clarify results
• If IgA is low (IgA deficiency), IgG-based tests may be used instead

Gastroscopy (endoscopy)

If blood tests suggest coeliac disease, adults are typically referred for an endoscopic biopsy of the small bowel to confirm the diagnosis.

Your consultant will also assess for nutritional deficiencies (such as iron, folate, vitamin B12 and vitamin D) and discuss whether any additional tests are needed.

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Treatment and management

The main treatment for coeliac disease is a strict, lifelong gluten-free diet, which allows the bowel lining to heal and helps symptoms improve.

Your plan may include:

Gluten-free diet support

• Dietitian guidance on avoiding gluten and maintaining balanced nutrition
• Advice on preventing cross-contamination at home and when eating out
• Support with label reading and safe alternatives

Correcting deficiencies and monitoring recovery

• Treating low iron/folate/B12 and vitamin D/calcium if needed
• Follow-up blood tests to check antibody levels and nutritional markers
• Symptom monitoring and review of ongoing risks

Managing complications (where relevant)

If symptoms persist despite a gluten-free diet, your consultant may assess for:

• Ongoing gluten exposure (most common reason)
• Irritable bowel syndrome overlap
• Lactose intolerance during healing
• Less common causes such as refractory coeliac disease (specialist pathway)

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Possible complications (if untreated)

Untreated coeliac disease can increase the risk of:

• Nutritional deficiencies and anaemia
• Bone thinning (osteopenia/osteoporosis)
• Fertility problems (in some cases)
• Ongoing fatigue and reduced quality of life

Good adherence to a gluten-free diet significantly reduces these risks.

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When to seek urgent help

Seek urgent medical advice if you have:

• Vomiting blood or black, tarry stools
• Severe abdominal pain with fever or persistent vomiting
• Rapid weight loss, dehydration, or inability to keep fluids down
• Severe weakness, fainting, or signs of significant anaemia (e.g., breathlessness at rest)

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If you have ongoing digestive symptoms, unexplained anaemia, persistent fatigue, or a family history of coeliac disease, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.