Coeliac Disease: Causes, Symptoms, Diagnosis and Treatment

Coeliac disease is a lifelong autoimmune condition where the body reacts abnormally to gluten — a protein found in wheat, barley and rye. When someone with coeliac disease eats gluten, the immune system mistakenly attacks the lining of the small intestine, damaging the tiny, finger-like projections called villi. These villi are essential for absorbing nutrients from food.

Over time, this damage leads to poor nutrient absorption, which can cause a wide range of symptoms and long-term health complications if left untreated. In Australia, at least 1 in 70 people have coeliac disease, and it’s estimated that up to 80% remain undiagnosed — often because symptoms are subtle or mistaken for other gut issues.

What Are Symptoms of Coeliac Disease?

Coeliac disease affects everyone differently. Some people experience classic digestive symptoms, while others have more general or non-digestive signs.

Common symptoms include:

• Bloating, abdominal pain or discomfort

• Chronic diarrhoea or constipation

• Unexplained weight loss

• Iron deficiency anaemia or other nutrient deficiencies (B12, folate, vitamin D)

• Fatigue or tiredness

• Mouth ulcers

• Skin rash (dermatitis herpetiformis)

• Osteoporosis (from long-term malabsorption)

How is Coeliac Disease Diagnosed?

Diagnosis involves blood tests and a gastroscopy with small bowel biopsy. It’s very important not to start a gluten-free diet before testing, as this can cause results to appear falsely normal.

1. Blood Tests

The first step is a simple blood test to check for tissue transglutaminase (TTG) antibodies. When a person with coeliac disease eats gluten, their body produces these antibodies, which can be detected in the blood.

2. Gastroscopy and Biopsy

If the blood test suggests coeliac disease, the next step is a gastroscopy. During this procedure, a thin tube with a camera (gastroscope) is passed through the mouth into the small intestine. Tiny samples (biopsies) are taken from the intestinal lining to confirm whether gluten has caused damage to the villi.

Treatment and Management of Coeliac Disease

Currently, there is no medication that cures coeliac disease. The only effective treatment is a lifelong, strict gluten-free diet.

With proper guidance from a dietitian experienced in coeliac disease, most people can transition smoothly to a gluten-free lifestyle while maintaining good nutrition and variety in their diet.

Long-Term Health and Follow-Up

If left untreated, coeliac disease can increase the risk of:

• Osteoporosis (weak bones)

• Infertility

• Nutrient deficiencies (iron, folate, vitamin D, B12)

• Intestinal lymphoma (rare)

Regular follow-up with your gastroenterologist ensures your intestine heals properly and helps detect any complications or deficiencies early.

The Future of Coeliac Disease Treatment

At present, the gluten-free diet remains the only proven treatment. By completely avoiding gluten, most people’s intestines heal and symptoms improve within weeks.

However, researchers are developing new therapies that may one day make life easier for people with coeliac disease. These treatments aim to reduce immune reactions, protect the gut lining, or help the body tolerate gluten exposure.

1. Helping the Gut Stay Strong

Medications such as larazotide acetate are being studied to strengthen the gut barrier and reduce inflammation if small amounts of gluten are eaten accidentally.
Other therapies, like gluten-digesting enzymes, are designed to break down gluten in the stomach before it can cause damage.

2. Calming the Immune Reaction

Drugs such as ZED1227 and IMU-856 aim to reduce the immune system’s overreaction to gluten and promote healing of the intestinal lining.

3. Training the Body to Tolerate Gluten

Some early studies are exploring vaccine-style treatments that could train the immune system to stop reacting to gluten altogether. While these are still in development, they offer exciting hope for the future.

Authored by Dr Walid Abu Shawish MBBS(Hons) BPharm(Hons) PGCertClinPharm FRACP.
Windsor, Melbourne Located Private Gastroenterologist & Advanced Endoscopist. For referral or contact information click here.