Complaints & connections · borters.ch
Not an intolerance but an immune reaction to gluten that damages the small intestine — consistently avoided, it heals again.
Also known as: celiac disease · gluten intolerance (autoimmune)
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In coeliac disease the immune system reacts to gluten, the protein of wheat, rye and barley, and in doing so turns against the lining of the small bowel. The fine villi with which the gut takes up nutrients flatten; the absorbing surface shrinks. This is not an intolerance that can be dosed but an autoimmune disease — and there lies the key difference from gluten sensitivity, in which symptoms occur without the gut being damaged. The picture is far broader than the phrase bowel disease suggests: a large share of those affected have hardly any bowel symptoms and instead stand out through a stubborn iron deficiency, through tiredness, through early low bone density, through recurring mouth ulcers or an itchy blistering rash. Decisive for the road to diagnosis is a rule often learned too late: testing is done on a gluten-containing diet. Cutting it out beforehand makes the investigation useless and leaves the choice of eating for months what does not agree with you, or staying without a diagnosis. Transglutaminase antibodies are measured together with total IgA, and in adults confirmation comes from a tissue sample. The treatment is gluten-free for life — kept to consistently, the lining recovers.
Recurring sores in the mouth can occur without the belly ever causing complaints. With repeats it is worth looking at iron, B12, folate — and at coeliac disease itself.
The single most important sentence. On a gluten-free diet, antibodies and tissue return to normal — the diagnosis then cannot be made without eating it again for months.
With an IgA deficiency the usual test is falsely negative. Without that second value a normal result can mislead.
Soy sauce, beer, many ready-made sauces, malt. The shared toaster and shared bread board count too — even small amounts keep the inflammation awake.
Antibodies and nutrients belong checked. If symptoms persist despite a strict diet, hidden gluten is often behind it — or something else alongside.
For people without coeliac disease, avoiding it achieves nothing and often costs fibre. For those affected it is the treatment — not a way of eating.
Fatty stool, wind and weight loss with flattened small-bowel villi look very like coeliac disease. Before a lifelong diet the stool sample is worth doing.
There is no medicine. The gluten-free diet is the treatment — and it works: antibodies fall over months, the villi of the small intestine rebuild over months to two years.
About one in a hundred people has coeliac disease; a large share do not know. Several years often pass between the first symptoms and the diagnosis. On a gluten-free diet the antibodies fall over six to twelve months, the villi need up to two years.
Often the only sign. An iron deficiency with no identifiable source of bleeding that does not hold despite iron is one of the best reasons to test for coeliac disease.
The classic picture — but by no means in everyone. Some even have constipation or no bowel symptoms at all.
Common and easily overlooked, because on their own they seem harmless. Together with tiredness and iron deficiency they make a pattern.
A skin form of the same disease. It can occur without bowel symptoms and clears under a gluten-free diet.
A consequence of poor absorption over years. In children permanent grooves can remain in the enamel.
Siblings and children of those affected have a clearly higher risk. A test is worthwhile there even without symptoms.
In the first months after diagnosis, while the villi recover. Iron, folate, B12, calcium and vitamin D are most often low — targeted after measurement beats blanket cover.
The most common deficiency in coeliac disease, often already before the diagnosis. After starting the gluten-free diet uptake recovers over months — then measure again rather than keep supplementing.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Coeliac disease and thyroid conditions occur together far more often than chance would predict — both are autoimmune. That is the reason to measure TSH once, even without complaints.
The damaged small-bowel lining takes up calcium and vitamin D poorly. This is why bone density belongs to the first work-up — some of those affected already have marked bone loss at diagnosis.
Untreated, coeliac disease goes more often with cycle disturbances, a later first period and fertility problems. On a consistently gluten-free diet this recedes for some.
The only causal treatment.
The gluten-free diet is not an alternative here but the treatment — lifelong and strict.