Patient information · Gastroenterology
Coeliac disease
why you must not go gluten-free before testing
Coeliac disease is an autoimmune reaction to gluten that damages the lining of the small intestine. It affects around one in a hundred people, most of whom are undiagnosed, and it is far more than a digestive problem — many people present with anaemia, fatigue or bone problems and no gut symptoms at all.
Seek prompt assessment if you have
- unexplained weight loss, or persistent diarrhoea
- iron, B12 or folate deficiency without an obvious cause
- severe abdominal pain with vomiting, or blood in the stool
- a very itchy blistering rash on the elbows, knees or buttocks
- failure to thrive or delayed puberty in a child
Dermatitis herpetiformis — the intensely itchy blistering rash — is coeliac disease presenting in the skin and needs the same treatment. Persistent unexplained anaemia in an adult always warrants coeliac testing alongside other investigations.
Keep eating gluten until you have been tested
This is the single most important thing on this page. The blood test and the biopsy both detect the immune response and the damage caused by gluten — remove gluten and both normalise, producing a false negative and leaving you without a diagnosis. You need to be eating gluten in more than one meal every day for at least six weeks before testing. If you have already gone gluten-free and feel better, do not simply carry on: a formal diagnosis matters for follow-up, for family screening, and for prescription and support entitlements. Come and discuss reintroduction with us.
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.
Book an appointment if you have symptoms and have not been tested, you have a first-degree relative with coeliac disease, or you went gluten-free without a diagnosis and want it established properly. We offer coeliac serology and annual review on site, and arrange endoscopy and dietitian input through our CQC-registered partners.
Coeliac testing on site, endoscopy arranged fast
Seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.