Marina was 27 years old when she realised something wasn't right. It wasn't just "a weak stomach". It was bloating after almost every meal, bathroom visits that changed pattern for no apparent reason, a tiredness that sleep didn't resolve. She spent months thinking it was work-related stress, until she decided to seek medical help and discovered she was living with an inflammatory bowel disease. Stories like Marina's happen quite often, and that's why it's worth knowing the signs that the body usually gives before diagnosis.

"The data and clinical case cited in this article are fictitious and are for purely illustrative purposes, serving to facilitate understanding of the topic addressed."

What are these two diseases, after all

Coeliac disease and Crohn's disease are different conditions, but sometimes confused because they affect the intestine and cause similar symptoms at first.

Coeliac disease is an immune system reaction to gluten, a protein present in wheat, rye and barley. When a coeliac person eats gluten, the body itself attacks the lining of the small intestine, which interferes with nutrient absorption.

Crohn's disease, on the other hand, is a type of inflammatory bowel disease, in which the immune system causes chronic inflammation in any part of the digestive tract, from the mouth to the anus, being most common at the end of the small intestine and the beginning of the large intestine.

The first signs of coeliac disease

Symptoms vary greatly from person to person, which makes diagnosis take longer. The most common ones include:

  • frequent diarrhoea or, on the contrary, constipation
  • bloating and gas after meals
  • recurrent abdominal pain or discomfort
  • persistent tiredness, even sleeping well
  • weight loss for no apparent reason
  • anaemia due to iron deficiency that doesn't improve with supplementation
  • recurrent mouth ulcers
  • in children, difficulty growing and gaining weight

It's worth noting that some adults don't feel any obvious digestive symptoms. Sometimes the first sign is an itchy skin rash (called dermatitis herpetiformis), infertility with no apparent cause, or early osteoporosis.

The first signs of Crohn's disease

Here symptoms tend to be more persistent and often include:

  • abdominal pain, often on the right side, in the lower part of the belly
  • diarrhoea that may be accompanied by blood or mucus
  • recurrent low-grade fever
  • unintentional weight loss
  • fatigue that interferes with daily activities
  • mouth ulcers
  • fissures or fistulas around the anus

Crohn's disease can also manifest outside the intestine, with joint pain, eye inflammation or skin lesions.

When these symptoms stop being "just a sensitivity" and deserve investigation

Isolated and temporary digestive symptoms happen to everyone. What draws attention to more careful investigation is the combination of:

  • symptoms that persist for more than two or three weeks
  • blood in the stools, even in small amounts
  • weight loss without being on a diet
  • tiredness that doesn't improve with rest
  • symptoms that interrupt sleep at night
  • family history of coeliac disease, Crohn's or another autoimmune disease

None of these signs, in isolation, means that the person has one of these diseases. They only indicate that it's worth talking to a doctor to investigate the cause.

What the path to diagnosis usually looks like

The first step is always a consultation with a general practitioner or gastroenterologist, who will listen to the symptom history and examine the person. From there, the most commonly used tests are:

  • blood tests, including specific antibodies that help screen for coeliac disease
  • upper digestive endoscopy with small intestine biopsy, to confirm coeliac disease
  • colonoscopy with biopsies and, in some cases, small intestine imaging tests, to investigate Crohn's
  • faecal calprotectin test, which helps identify intestinal inflammation

It's important not to stop eating gluten on your own before investigating coeliac disease, because this can alter the test results and delay the correct diagnosis.

Recognising these signs early is not cause for alarm, it's cause for being informed and seeking evaluation. Many people live well with these conditions after they receive the correct diagnosis and appropriate treatment.

This content is educational in nature and does not replace a medical consultation. Each person is unique, and the diagnosis and treatment of these conditions should be done by a healthcare professional, based on individual assessment.

Dr Rebeca Soares Andrade CRM - GO 39335