Coeliac disease

Coeliac disease is an autoimmune condition in which eating gluten damages the lining of the small intestine. Gluten is a protein found in wheat, rye, barley, and their products — so in Indian diets, it's in atta/maida (wheat flour), suji (semolina), rava, dalia, and many commercial foods. Coeliac disease was once considered rare in India, but it's now known to be common — studies suggest roughly 1% of Indians in wheat-eating regions have it, with highest prevalence in North India.

Symptoms

Symptoms vary widely. Some people are very ill; others have subtle symptoms or are even picked up only on testing:

Digestive symptoms:

• Chronic diarrhoea or, in some people, constipation
• Abdominal pain and bloating
• Gas
• Pale, foul-smelling stools
• Nausea or vomiting
• Weight loss or failure to gain weight

Non-digestive symptoms (can occur without digestive symptoms):

• Iron-deficiency anaemia that doesn't respond to iron supplements
• Tiredness, weakness
• Poor growth in children, delayed puberty
• Skin rash (dermatitis herpetiformis — itchy blistering rash)
• Mouth ulcers
• Joint pain
• Infertility or recurrent miscarriages
• Bone pain, osteoporosis
• Headaches, brain fog, tingling/numbness
• Enamel defects in teeth

Diagnosis

Diagnosis is in two main steps:

• Blood tests for coeliac antibodies (tissue transglutaminase antibody / tTG-IgA, with total IgA level). Do these BEFORE starting a gluten-free diet — otherwise the tests may be falsely negative.
• Endoscopy with small-bowel biopsy — the definitive test; shows characteristic damage to the intestinal lining
• Genetic testing (HLA-DQ2 / HLA-DQ8) — can rule the condition out; positive result alone doesn't confirm diagnosis

If symptoms persisted on a gluten-containing diet, you'd restart gluten for 6-8 weeks (a "gluten challenge") before testing — under medical supervision — to get accurate results.

Treatment

The only treatment is a strict, lifelong gluten-free diet. This is challenging but effective — with adherence, intestinal damage heals and symptoms resolve. For Indian readers:

• Avoid — wheat (atta, maida, suji, rava, dalia), rye, barley (jau), triticale, malt; most commercial biscuits, breads, namkeens, packaged snacks; soya sauce, some asafoetida brands, many gravies thickened with wheat
• Safe grains — rice, millets (ragi, jowar, bajra, kodo, little millet), maize (makki), amaranth (rajgira), buckwheat (kuttu), quinoa — and pulses, dals, fruits, vegetables, meat, fish, eggs, dairy (unless separately intolerant)
• Read labels for hidden gluten in packaged foods
• Be careful of cross-contamination in kitchens — shared utensils, wheat flour dust

Regular follow-up with a gastroenterologist and dietitian is important. Check bone density, iron, B12, folate, vitamin D, and thyroid — coeliac disease is associated with multiple other autoimmune conditions. First-degree relatives should also be screened, as coeliac runs in families.