Around 1 in 100 people have it, and most are undiagnosed — often labelled as IBS for years.
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Coeliac disease is an autoimmune condition in which the immune system reacts to gluten — the protein in wheat, barley and rye — and damages the lining of the small bowel. That damage impairs absorption of iron, calcium, vitamin D, B12 and folate, which is why so much of the illness happens a long way from the gut.
It is not an allergy and it is not an intolerance. Gluten does not simply disagree with you; your immune system attacks your own bowel lining in response to it. That distinction matters, because it is why a small amount does damage even when it causes no symptoms.
Around one in a hundred people has it. Most of them do not know. Average delay to diagnosis in the UK is still measured in years, for two reasons:
So the single most useful sentence on this page is this: do not stop eating gluten until you have been tested. If you have already stopped, do not despair — but tell us, because it changes what we do next and it is fixable.
In genetically susceptible people, gluten triggers an immune reaction that flattens the villi — the tiny finger-like projections lining the small bowel that create its absorptive surface. Less surface means poorer absorption of iron, calcium, vitamin D, folate and B12, and the consequences appear all over the body.
The lining recovers on a gluten-free diet, which is why the treatment works so completely when it is followed strictly.
Untreated coeliac disease carries real long-term consequences: osteoporosis, iron deficiency, infertility and pregnancy complications, and a small increased risk of small bowel lymphoma — a risk that falls substantially with a strict gluten-free diet. A confirmed diagnosis also brings monitoring, bone density assessment, vaccinations, family screening, and in some areas prescription support. Going gluten-free without a diagnosis gets you the diet and none of that.
You must be eating gluten — at least one normal meal containing it every day — for a minimum of six weeks before the blood test, and continuing until any biopsy is done.
Cutting gluten out beforehand lets the bowel heal and the antibodies fall, so the test comes back negative whether or not you have the condition. This is the commonest reason coeliac disease goes undiagnosed for years, and almost nobody is told it before they start experimenting.
If you have already gone gluten-free, tell us. The options are a gluten challenge — reintroducing it for six weeks, which is unpleasant if you genuinely have coeliac disease — or genetic testing, discussed below.
Alongside, we check for the consequences: full blood count, ferritin, B12 and folate, vitamin D, calcium, liver function and thyroid function. Our coeliac screening test covers the core panel.
In adults, an endoscopy with small bowel biopsies remains the confirming test, and it is done under sedation as a day case. We refer.
Keep eating gluten until it is done. Stopping beforehand allows healing and produces a normal biopsy — which is the second commonest way the diagnosis is lost.
In children with very high antibody levels, a no-biopsy pathway is now accepted, which spares many of them the procedure.
HLA-DQ2 and DQ8 testing is useful in one direction only. A negative result effectively rules coeliac disease out, which is genuinely valuable for someone already gluten-free who cannot face a challenge. A positive result proves nothing — around a third of the population carries these genes and almost none of them have coeliac disease.
IgG "food intolerance" panels, hair analysis and similar tests sold online have no diagnostic validity for coeliac disease or anything else. We will not act on them, and they routinely send people gluten-free without a diagnosis — which is the worst of both outcomes.
We can do the whole diagnostic pathway short of the endoscopy itself, and all of the follow-up.
The most valuable thing we do here is get the testing right: tTG-IgA with total IgA, in someone who is still eating gluten, alongside a full nutritional screen. That single combination avoids most of the missed diagnoses.
There is no medication. The diet is the treatment, and it works — the bowel lining recovers, symptoms resolve, and the long-term risks fall substantially.
Frequently overlooked once the diet is started:
Most often the answer is hidden gluten rather than treatment failure — cross-contamination at home, oats, medication excipients, or eating out. Beyond that we consider lactose intolerance from bowel damage, coexisting IBS, small intestinal bacterial overgrowth, or — rarely — refractory coeliac disease, which needs specialist care. Rising antibodies after good control almost always means gluten is getting in somewhere, and finding it is usually a dietetic job rather than a medical one.
Coeliac disease is rarely an emergency. Seek urgent medical attention for:
Seek prompt assessment for:
Book a consultation for testing if you have:
Keep eating gluten. One normal gluten-containing meal a day, for at least six weeks before the blood test and right up until any biopsy. It is the difference between a diagnosis and a decade of not knowing.
Wheat, barley and rye — and a long list of places you would not look:
Small amounts matter, because the reaction is immunological rather than dose-dependent in the ordinary sense:
Oats themselves do not contain gluten but are usually contaminated during milling. Use only oats labelled gluten-free — and note that a small minority of people with coeliac disease react even to pure oats, so reintroduce them deliberately and watch what happens.
The single most important thing about coeliac testing is free, and getting it wrong wastes months: you must be eating gluten when the blood test is taken.
Gluten in more than one meal a day for at least six weeks before testing — otherwise the antibodies disappear and the test is falsely negative. Going gluten-free first, then asking to be tested, is the commonest and most frustrating error, and it means either restarting gluten for six weeks or never getting a definite answer.
NHS testing and diagnosis are free, and this matters more than usual: a confirmed NHS diagnosis gives access to gastroenterology follow-up, dietetic support, bone density monitoring, and — in some areas — prescriptions for staple gluten-free foods. A privately obtained diagnosis without endoscopic confirmation may not open those doors.
We would therefore steer you toward the NHS pathway rather than a private test, which is unusual advice for a private service to give and is the honest one.
What we will not arrange: home fingerprick coeliac kits sold direct to the public, which produce both false positives and false negatives, and IgG food intolerance panels, which have no diagnostic value.
Where a private consultation adds something is arranging correct serology quickly, checking ferritin, B12, folate and vitamin D — deficiencies are common at diagnosis — and testing first-degree relatives, who carry roughly a one in ten risk.
NICE NG20, Coeliac disease: recognition, assessment and management, is the governing guideline. It recommends serological testing — total IgA and IgA tissue transglutaminase — as first-line, and is explicit that testing is only accurate if gluten is being eaten.
NG20 specifies gluten in more than one meal a day for at least six weeks before testing, which is the basis for the point above.
NG20 recommends offering testing to people with persistent unexplained gastrointestinal symptoms, faltering growth, prolonged fatigue, unexplained iron, B12 or folate deficiency, type 1 diabetes and autoimmune thyroid disease, and to first-degree relatives.
NG20 recommends referral for endoscopic biopsy to confirm the diagnosis in adults, since a lifelong dietary change should rest on a secure diagnosis.
NG20 also recommends assessment of bone health and annual review including nutritional status.
Yes, and it is worth doing properly. Feeling better on a gluten-free diet does not distinguish coeliac disease from gluten sensitivity or IBS, and the difference matters enormously — coeliac disease brings bone monitoring, family screening, vaccination and a lymphoma risk that adherence reduces. To test now you would need a six-week gluten challenge, or a genetic test, which can rule it out if negative. Come and talk it through rather than staying in limbo.
At least one normal gluten-containing meal a day, for a minimum of six weeks — and keep going until any biopsy is done. Cutting it out lets the bowel heal and antibodies fall, so the test reads negative regardless. This is the single commonest reason coeliac disease is missed, and it is almost never explained to people beforehand.
Three possibilities worth checking. Were you eating gluten at the time? Was total IgA measured alongside? — IgA deficiency causes a false negative and is ten times more common in coeliac disease. And if both were correct, this may be non-coeliac gluten sensitivity or a FODMAP issue, where the fermentable carbohydrates in wheat rather than the gluten cause the symptoms.
No. It is an autoimmune condition — your immune system damages your own bowel lining in response to gluten. That is why even amounts too small to cause any symptoms still do harm, and why "a little bit won't hurt" is not true here in the way it might be for an intolerance.
Yes — around one in ten first-degree relatives has it, usually without symptoms they have connected to anything. Parents, siblings and children should be tested, and repeated later if symptoms develop. It is one of the most useful things to come out of a diagnosis, and it is routinely not passed on.
Usually, if they are labelled gluten-free — ordinary oats are contaminated during milling rather than containing gluten themselves. A small minority of people with coeliac disease react even to pure oats, so introduce them deliberately, one product at a time, and see what happens rather than assuming either way.
You may get symptoms for a day or two, or nothing at all — and the absence of symptoms is not reassurance, because the immune damage happens regardless. One accidental exposure will not undo your progress. Repeated small exposures will. If your antibody levels are creeping up, gluten is getting in somewhere, and a dietitian is usually better at finding it than more blood tests.
Yes — it is lifelong, and there is currently no medication that replaces it, though treatments are in development. The compensation is that it works completely: the bowel heals, the deficiencies correct, and the long-term risks fall back close to normal with strict adherence.
No. For people without coeliac disease it offers no proven benefit, and gluten-free processed foods are often lower in fibre and higher in sugar and fat. The more important point: going gluten-free "just in case" makes coeliac disease impossible to diagnose properly — so if you suspect gluten is a problem, get tested first.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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