Private coeliac disease clinic in London, same-day gastroenterology.

How it presents

• Gut symptoms — bloating, wind, diarrhoea or constipation, abdominal pain, nausea. Frequently mislabelled as IBS.
• Fatigue, which is often the dominant complaint.
• Iron, B12 or folate deficiency, and anaemia that does not respond well to supplements.
• Mouth ulcers, and dental enamel defects.
• Osteoporosis or unexplained fractures, from poor calcium absorption.
• Neurological symptoms — tingling, balance problems, headaches.
• Unexplained infertility or recurrent miscarriage, and in children poor growth.

Diagnosis

A positive blood test is usually followed by an endoscopy with biopsies to confirm the diagnosis, though in some circumstances a very high antibody level allows diagnosis without one. Testing is also recommended for first-degree relatives, in whom the risk is around one in ten, and for people with type 1 diabetes, autoimmune thyroid disease and other associated conditions.

Living gluten-free

• The treatment is a strict, lifelong gluten-free diet — no wheat, barley or rye. Even small amounts cause damage, including in people who feel no symptoms.
• Cross-contamination matters: shared toasters, butter, chopping boards, fryers and pasta water. A separate toaster and butter dish is not fussiness.
• Oats are tolerated by most but must be certified gluten-free, and a minority react even to those.
• Check medicines, supplements and communion wafers, and beer, which contains barley.
• A dietitian referral is part of proper care, not an optional extra — the diet is harder than it sounds and deficiencies are common without guidance.
• Coeliac UK membership is genuinely useful for food lists and eating out.

Long-term follow-up

Coeliac disease needs annual review, not diagnosis and discharge. That should include weight, symptoms, antibody levels to check adherence, and blood tests for iron, B12, folate, calcium and vitamin D. A bone density scan is recommended at diagnosis or after the menopause, since osteoporosis risk is raised. You should also be offered the pneumococcal vaccine, as spleen function can be reduced.