Coeliac Disease, Food Intolerances & Malabsorption

Common symptoms

• Diarrhoea, loose or greasy stools
• Bloating, wind and abdominal discomfort after eating
• Tiredness and low energy
• Unexplained weight loss
• Iron deficiency anaemia or low B12, folate or vitamin D
• Mouth ulcers
• An itchy, blistering skin rash (dermatitis herpetiformis)
• Symptoms after dairy or particular foods

Conditions diagnosed and managed

• Coeliac disease
• Gluten-related digestive problems
• Lactose intolerance
• Food intolerances
• Nutritional deficiencies (iron, B12, folate, vitamin D)
• Malabsorption disorders

What is coeliac disease?

Coeliac disease is an autoimmune condition in which eating gluten — found in wheat, barley and rye — damages the lining of the small bowel. This reduces the body’s ability to absorb nutrients. It affects around 1 in 100 people in the UK, but many remain undiagnosed because symptoms can be mild or unusual.

Coeliac disease testing and diagnosis

Testing starts with a blood test for coeliac antibodies. In adults, the diagnosis is usually confirmed with a gastroscopy and small bowel biopsies.

Gluten-related digestive problems

Some people get symptoms from wheat or gluten without having coeliac disease. This may be due to sensitivity to the fermentable carbohydrates in wheat, which overlaps with IBS, rather than gluten itself. Excluding coeliac disease properly first is essential, because the implications are very different.

Lactose intolerance and other food intolerances

Lactose intolerance occurs when the gut produces too little of the enzyme needed to digest milk sugar, causing bloating, wind and diarrhoea after dairy. It can be primary, or secondary to another condition such as coeliac disease or a recent infection. Other food intolerances are common, but commercially sold “intolerance tests” are generally unreliable — a structured, specialist-guided approach is far more useful. Food allergies that cause hives, swelling or breathing problems are a separate issue and need an allergy assessment.

Malabsorption and nutritional deficiencies

Malabsorption means the gut is not absorbing nutrients properly. Clues include unexplained weight loss, pale or greasy stools that are hard to flush, and deficiencies in iron, B12, folate or vitamin D. Causes include coeliac disease, pancreatic insufficiency, bile acid problems, small bowel bacterial overgrowth and Crohn’s disease.

How Dr Khalid investigates the problem

Dr Khalid will review your symptoms, diet and any previous results. Investigations may include:

• Coeliac antibody blood tests (while you are still eating gluten)
• Blood tests for iron, B12, folate, vitamin D and other nutrients
• A gastroscopy with small bowel biopsies
• Breath tests for lactose intolerance or bacterial overgrowth where available
• Stool tests to assess pancreatic function

Treatment and management

Coeliac disease is treated with a strict, lifelong gluten-free diet, ideally supported by a dietitian, with follow-up to check that the gut is healing and deficiencies are corrected. For intolerances, the aim is to identify true triggers and keep your diet as varied as possible. Where malabsorption is found, the underlying cause is treated and nutritional deficiencies are replaced.

When should you see a gastroenterologist?

See a specialist if you think food is triggering your symptoms, have a family history of coeliac disease, have unexplained anaemia or vitamin deficiencies, or have a positive coeliac blood test.

Book a private consultation at Spire Cheshire in Warrington or The Highfield Hospital in Rochdale.

Frequently asked questions