Coeliac disease and most common symptoms

Coeliac disease is a condition caused by gluten, a protein found in wheat, barley and rye. It is a lifelong autoimmune disorder that causes the malabsorption of certain nutrients.

Coeliac disease is significantly more common than previously thought. Some people have it unknowingly, as the symptoms of coeliac disease can be mild for a long time. The disease is prevalent in Western countries, where the diet is based on cereals that cause coeliac disease: wheat, barley and rye. These days, coeliac disease does not prevent the consumption of oats, as long as they are pure oats and are not mixed with cereals that cause coeliac disease.

Who can get coeliac disease?

The actual cause of coeliac disease is unknown, but strong genetic predisposition is one of the risk factors. The heredity of coeliac disease is approximately 10–20%.

Other risk groups include people with certain autoimmune diseases, such as diabetes in adolescence, certain thyroid diseases and Sjogren's syndrome. In high-risk groups, screening for coeliac disease using coeliac antibody testing is recommended if even the slightest suspicion of coeliac disease arises.

The onset of coeliac disease can occur at any age if the diet includes cereals like wheat, barley and rye. On average, the disease is diagnosed at the age of 40 in Finland. Approximately 1% of children in Finland suffer from coeliac disease.

“Coeliac disease is quite common among preschoolers. If a diet that contains lots of gluten is started at an early age, the onset of the disease can occur slightly earlier than usually,” says paediatrician Timo Klemola.

8 most common symptoms of coeliac disease

Typical symptoms of coeliac disease include:

  • various intestinal problems
  • prolonged diarrhoea
  • watery stool
  • flatulence
  • swollen belly
  • stomach cramps
  • loss of appetite
  • vomiting.

According to Klemola, lactose intolerance can also be a symptom of coeliac disease. Untreated coeliac disease is associated with secondary lactase deficiency, and in addition to a gluten-free diet (in Finnish), patients are advised to reduce the use of lactose in the early phases of the treatment of coeliac disease.

Coeliac disease does not always manifest as abdominal symptoms

Not all people with coeliac disease experience any stomach issues or other clear symptoms.

Coeliac disease was previously considered to only produce symptoms of the stomach or skin. These days, we know that some people with coeliac disease do not experience any stomach issues or other clear symptoms. Coeliac disease can also cause anaemia and tiredness.

Tiina Kojo, a specialist in internal medicine and gastroenterology, says that coeliac disease often includes other symptoms besides diarrhoea and stomach issues.

“The levels of liver enzymes may be elevated due to untreated coeliac disease. In most cases of determining the causes of infertility, the possibility of coeliac disease as an underlying condition is ruled out even if no symptoms have manifested,” says Tiina Kojo.

The growth of children may be slower due to coeliac disease.

“In its most severe forms, coeliac disease can cause nutritional and growth disorders. In a typical case of coeliac disease in an infant, the malnourished baby has a round bloated stomach, thin extremities and a growth disorder. Fortunately, such cases are very rare nowadays,” says paediatrician Timo Klemola.

Learn more: Coeliac disease in children – a common condition (in Finnish)

What does coeliac disease do?

Coeliac disease causes inflammation of the surface of the small intestine and damage to the intestinal villi. It leads to malabsorption of nutrients and thus to various problems, such as anaemia, osteoporosis, problems of the nervous system and growth and development disorders in children.

The rash associated with coeliac disease is called dermatitis herpetiformis. The rash consists of itchy blisters and often appears on the elbows and knees.

Coeliac disease can also cause liver damage, infertility and tooth enamel damage. Abdominal symptoms of coeliac disease may appear as diarrhoea, but some people only experience flatulence, loose stools or mild abdominal pain. Some patients with coeliac disease do not have any abdominal symptoms or only have mild symptoms.

Untreated coeliac disease slightly increases the risk of cancer in the small intestine.

How is coeliac disease diagnosed?

Coeliac disease screening can be performed as a blood test if another member of the family has been diagnosed with the disease. Asymptomatic diseases and diseases with only mild symptoms are also detected in the screening test. However, in addition to the blood test, a small intestine biopsy will also be taken as confirmation, if necessary.

“A simple blood test is not always enough to make an accurate diagnosis. “The actual diagnosis of coeliac disease is based on a biopsy of the small intestine. In the biopsy study, lesions in the mucosa of the small intestine typical to coeliac disease can be detected. Small children are usually placed under general anaesthesia during the procedure,” says pediatrician Timo Klemola.

When examining dermatitis herpetiformis, a biopsy is performed under local anaesthesia on healthy skin close to the rash area.

The pathologist examines the biopsies under a microscope and looks for changes typical of coeliac disease, i.e. loss of villi in the small intestine, depression of crypts and inflammatory cells.

In dermatitis herpetiformis, so-called IgA deposits are present on the skin.

The treatment of coeliac disease requires precision

The only method of treating coeliac disease is to follow a precise and lifelong gluten-free diet. The diet completely avoids wheat, rye and barley.

Klemola knows that avoiding cereals in your diet is difficult, as many processed foods include wheat, for example.

“Rice, corn, buckwheat and millet are risk-free alternatives,” he says.

Oats can also be consumed in moderation.

“Children with coeliac disease can eat pure oats, and oatmeal is a perfect option for breakfast. However, it is very important to read the list of ingredients of various products carefully. For example, oat bread sold in the stores often contains lots of wheat.”

Remember, you are not alone with your symptoms. Help is available.

Specialists and locations

Markku Aarnio
Gastrokirurgian erikoislääkäri, LT, Dosentti
Samuli Aho
Gastroenterologisen kirurgian erikoislääkäri
Juha Grönroos
Vatsaelinkirurgian professori, ylilääkäri
Jussi-Pekka Haikio
LL,Sisät.- ja gastroenterologian erikoislääkäri