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Coeliac disease is another name for a gluten allergy (also called gluten-sensitive enteropathy) – which is not the same thing as a gluten intolerance. What happens in coeliac disease is that the gluten proteins yield toxic fragments, or peptides, that damage the delicate cells of the intestinal lining. Over time, the surface area of the small intestine becomes damaged, causing a flattening or atrophy of the microvilli (tiny hairs that help with the transportation of food through the intestine). This leads to malabsorption of all nutrients (vitamins, minerals, fats, proteins and carbohydrates) and, typically, weight loss, although many other conditions can ensue as well.

The reason this occurs is not wholly understood, but one theory is that there is a lack of appropriate digestive enzymes. Another theory is that the immune system perceives a part of the gluten protein to be ‘foreign’ and attacks it. In the ensuing battle, the immune system inadvertently damages the intestinal lining.

The symptoms include bloating, diarrhoea, foul-smelling stools, pale stools, and poor growth in babies and children. In adults there can also be pain, malaise, weakness and weight loss. Fatigue and irritability are also common. The skin and tongue may appear pale due to a lack of the normal red pigment found in blood. Bone problems may occur, such as deformity, pain or propensity to fracture.

Since nutrients are incompletely absorbed, increased bowel frequency, with the passage of bulky, pale stools, may occur; there may be associated abdominal pain and/or distension. However, many sufferers experience no bowel disturbance, and may be constipated rather than suffer diarrhoea.

It is likely that many people with gluten sensitivity have few or no symptoms, so the condition can remain unrecognized.