Have you ever found that, after eating a delicious pastry or a plate of pasta, you’re plagued by unpleasant bloating, stomach ache or tiredness? Many people simply assume it is down to poor digestion, yet there is often a more complex problem underlying it: gluten sensitivity. It is important to understand that this is not a single condition, but an umbrella term that encompasses several conditions triggered by gluten.
Many people are afraid of the diagnosis and the lifestyle changes it entails, but with the right knowledge and expert help, the symptoms can be managed effectively and you can lead a full, symptom-free life. In this article, we take a detailed look at the different types of coeliac disease, its symptoms and the diagnostic process, and we provide practical advice on how to follow a gluten-free diet. The Endomedix Gastroenterology Centre As experts in this field, our aim is to provide you with all the information you need so that you can manage your condition with confidence.
What exactly is gluten, and why can it cause problems?
Gluten is a protein complex found naturally in many cereals, such as wheat, barley and rye. This substance is responsible for the elasticity of dough and helps bread to retain its shape. Although consuming gluten is completely harmless for most people, in certain cases the body may react to it with an abnormal immune response or other unpleasant symptoms.
There are three main types of gluten-related problems:
- Coeliac disease (gluten-sensitive enteropathy): This is an autoimmune disease in which the consumption of gluten triggers an immune response, leading to damage to the lining of the small intestine and the atrophy of the intestinal villi.
- Wheat allergy: This is a classic food allergy, in which the immune system reacts to the proteins found in wheat – including gluten – by triggering an allergic reaction (e.g. a skin rash, breathing difficulties).
- Non-coeliac gluten sensitivity (NCGS): This is a condition about which little is known, in which the consumption of gluten causes symptoms typical of coeliac disease and food allergy, but tests do not confirm either condition.
These three conditions are based on different mechanisms, and their diagnosis and treatment also differ.
Coeliac disease: an autoimmune disorder
Coeliac disease is a genetically determined, systemic autoimmune disorder triggered by the consumption of gluten in susceptible individuals. Although it can develop at any age, it is often diagnosed in childhood or in our 30s and 40s. Worldwide, and in Hungary too, it affects approximately 1% of the population, and is two to three times more common in women.
How does coeliac disease develop?
The onset of the disease requires the combined presence of several factors:
- Genetic predisposition: Coeliac disease occurs almost exclusively in people who carry the HLA-DQ2 or HLA-DQ8 genes. It is important to note that the presence of these genes alone is not sufficient for the disease to develop, as 30–40% of the total population carry them.
- Environmental factors: Gluten intake is the most important environmental factor. Gliadin, one of the components of gluten that enters the body, triggers the immune response that leads to inflammation of the small intestine’s mucosa and the destruction of the intestinal villi.
The function of the villi is to absorb nutrients. If they are damaged, a malabsorption disorder develops, which can lead to nutrient deficiencies and a wide range of symptoms.
What symptoms might indicate coeliac disease?
The symptoms of coeliac disease can vary greatly and often affect more than just the digestive system.
Classic gastrointestinal symptoms:
- Chronic diarrhoea or constipation
- Abdominal pain, cramps
- Increased gas production, bloating
- Nausea, vomiting
- Fatty, foul-smelling stools that are difficult to flush away (steatorrhoea)
Extraintestinal symptoms:
- Iron deficiency anaemia: This is one of the most common symptoms in adulthood, caused by insufficient iron absorption.
- Fatigue, weakness: Due to nutrient deficiencies and chronic inflammation.
- Bone loss (osteopenia, osteoporosis): As a result of inadequate absorption of calcium and vitamin D.
- Unexplained weight loss: Due to a malabsorption disorder.
- Skin problems: The most common form is Duhring’s dermatitis herpetiformis, a highly itchy, blistering skin condition that typically affects the elbows, knees and buttocks.
- Symptoms affecting the nervous system: These may include coeliac ataxia (a disorder affecting balance and movement), peripheral neuropathy (numbness in the limbs) and headaches.
- Gynaecological problems: Menstrual disorders, infertility, miscarriages.
It is important to note that there is silent coeliac disease even when the patient has no noticeable symptoms, but damage to the small intestine and the presence of specific antibodies can be detected in their blood.
Non-coeliac gluten sensitivity (NCGS)
This is a relatively new and less well-understood condition. Patients with NCGS experience symptoms similar to those of coeliac disease following the consumption of gluten, such as abdominal pain, bloating, diarrhoea, headaches or a feeling of „brain fog”. The key difference is that neither the autoimmune process and damage to the villi characteristic of coeliac disease nor a wheat allergy can be detected in these patients.
The diagnosis of NCGS is currently based on a process of elimination: if tests have ruled out coeliac disease and wheat allergy, but symptoms show a clear improvement following a gluten-free diet and then reappear when gluten is reintroduced, then NCGS can be diagnosed.
Diagnosing coeliac disease: how is it done?
If your symptoms suggest that you may be gluten-intolerant, an accurate medical diagnosis is essential. Never start a gluten-free diet on your own before undergoing tests, as this may make it difficult or even impossible to reach the correct diagnosis! The diagnostic process consists of the following steps:
- Serological tests (blood tests): The first step is a simple blood test, which can detect specific antibodies characteristic of coeliac disease. Examples include IgA antibodies against tissue transglutaminase (tTG) and antibodies against endomysium (EMA). As some people with coeliac disease have an IgA deficiency, total IgA levels are also usually checked to avoid false-negative results.
- Genetic testing: Testing for the HLA-DQ2/DQ8 genes is also carried out using a blood sample. This test primarily has a negative predictive value: if these genes are not present, coeliac disease can be virtually ruled out.
- Small bowel biopsy: If the serological tests are positive, a small bowel biopsy is required to confirm the diagnosis. This is carried out as part of a gastroscopy. During the procedure, the doctor inserts a thin, flexible instrument (an endoscope) through the mouth and down the oesophagus to reach the initial section of the small intestine, from where they take small tissue samples. Histological examination of the samples clearly reveals the extent of damage to the intestinal villi. The Endomedix Gastroenterology Centre With modern equipment and experienced specialists, it ensures that the examination causes as little discomfort as possible.
The basis of treatment: a strict, lifelong gluten-free diet
The only effective treatment for coeliac disease and non-coeliac gluten sensitivity is the complete and permanent elimination of gluten-containing foods from the diet. This may seem daunting at first, but there are now plenty of gluten-free alternatives available, and with a little care, it is possible to put together a balanced and varied diet.
What should you avoid?
On a gluten-free diet, you must not consume any food or drink that contains wheat, barley, rye or their derivatives.
Prohibited cereals and ingredients:
- Wheat (in all forms: e.g. spelt, durum wheat, kamut)
- Barley (barley pearls, malt)
- Rye
- Triticale (a cross between wheat and rye)
- Traditional flours, semolina, wheat groats, flakes, bran
- Breadcrumbs
Common foods containing gluten:
- Bread, baked goods, biscuits, cakes, pastries
- Beer, malt-based drinks
- Cereal flakes, muesli
- Breaded meat and fish
- Ready meals, soup powders, sauces (may contain gluten as a thickening agent)
What can you eat?
Fortunately, many grains and ingredients are naturally gluten-free.
Ingredients that are safe to consume:
- Vegetables, fruit: It can be eaten fresh, frozen or in its unprocessed form.
- Meat, fish, eggs: In its natural state, unmarinated and without breadcrumbs.
- Milk and dairy products: Plain yoghurt, kefir, cottage cheese, cheese (take care with flavoured products).
- They are thin: Beans, lentils, chickpeas.
- Oily seeds: Walnuts, hazelnuts, almonds.
- Gluten-free grains: Rice, maize, millet, buckwheat, quinoa, amaranth. The consumption of oats may be a cause for concern due to the risk of cross-contamination; therefore, you should only buy oats that are certified as gluten-free.
- Gluten-free flours: Rice flour, maize flour, potato starch, buckwheat flour, almond flour, etc.
Watch out for hidden gluten and cross-contamination!
Gluten may also be hidden in many processed foods, where it is used as a thickener, flavour enhancer or stabiliser. It is therefore essential to read product labels carefully. Look for the words „gluten-free” or the symbol of a crossed-out ear of corn, which guarantees the product is safe.
You should also be aware of the risk of cross-contamination. This means that gluten-free food may come into contact with gluten during preparation in the kitchen. For example, bread sliced on the same chopping board, or fried meat and chips cooked in the same oil. At home, it is advisable to use a separate chopping board, wooden spoon and toaster for gluten-free foods.
What happens next after the diagnosis?
Receiving a diagnosis and making lifestyle changes can be difficult at first, but it is important to know that you are not alone. The Endomedix Gastroenterology Centre Our specialists and gastroenterologists provide support not only in making a diagnosis, but also in the long term. Regular check-ups help to monitor your condition and the effectiveness of your diet, and to identify any potential deficiencies (e.g. iron, vitamin B12 or vitamin D deficiency) in good time, which can then be addressed if necessary.
By strictly adhering to a gluten-free diet, the intestinal villi regenerate, symptoms disappear, and the risk of long-term complications of untreated coeliac disease (e.g. osteoporosis, infertility, and malignant tumours) is significantly reduced. Take steps to look after your health and book an appointment at our gastroenterology clinic, where we will help you identify the cause of your symptoms and find the right solution!
