Definition
Celiac disease is a chronic autoimmune disorder primarily affecting the small intestine. It is triggered by an immune reaction to gluten, a protein found in wheat, rye, and barley. In individuals with celiac disease, consuming gluten causes inflammation and damage to the small intestine, impairing the absorption of nutrients.
Pathogenesis
Celiac disease results from the interaction of genetic and environmental factors. People with certain genetic markers (such as HLA-DQ2 or HLA-DQ8) are more susceptible. In these individuals, the consumption of gluten triggers an autoimmune response that damages the lining of the small intestine.
Diagnosis
Diagnosis typically involves blood tests to detect antibodies associated with celiac disease. A biopsy of the small intestine via endoscopy may be performed to confirm damage to the intestinal lining.
Treatment
The primary treatment for celiac disease is a strict lifelong gluten-free diet. Avoiding gluten helps heal the small intestine and restore nutrient absorption. In some cases, supplementation with vitamins and minerals may be required to address deficiencies. Regular medical follow-up and patient education about dietary management are essential for successfully managing the condition.
Confirmation requires gastroscopy with duodenal biopsies. Wheat allergy and functional disorders such as functional dyspepsia must be distinguished from it.
- Serology: tissue transglutaminase IgA plus total serum IgA
- Confirmation in adults: gastroscopy with multiple duodenal biopsies
- Gluten must not be stopped before testing
- Treatment is a strict lifelong gluten free diet
Frequently asked questions
Which tests are needed?
First serology: tissue transglutaminase IgA antibodies together with total serum IgA, because selective IgA deficiency produces a false negative result. In adults, gastroscopy with multiple duodenal biopsies then confirms the diagnosis histologically. HLA DQ2 and DQ8 testing does not establish the diagnosis, it serves to exclude it.
Can I stop gluten before being tested?
No, and this is the single most common mistake. Both antibodies and biopsies must be obtained while you are still eating gluten. If you stop, antibody levels fall and the mucosa heals, so the result comes back negative and the diagnosis is missed. If you have already stopped, a controlled gluten challenge is planned before testing.
Is there a drug for coeliac disease?
No. There is no approved medication that treats the disease or allows gluten to be eaten. Treatment is a strict, lifelong gluten free diet, which is highly effective: symptoms usually resolve within weeks and the intestinal mucosa heals over months. Supplements are used only to correct deficiencies.
Sources
- Al-Toma A et al., European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. https://pubmed.ncbi.nlm.nih.gov/31210940/
Content last updated: September 2026 (14/09/2026).
