Everyone gets the feeling they've eaten too much occasionally. But those pains and swelling are constant for people with an autoimmune disorder called coeliac disease.

Many of those afflicted do not understand the source of their problems, say medical experts. Getting a proper diagnosis can be a long, painful journey. And a positive diagnosis of gluten intolerance means a lifetime of specialized diets. However, following that diet helps people control the problem. Grains are the root of the problem, which lies in the body's inability to process the protein gluten, found abundantly in barley, oats, rye, spelt and wheat. Sufferers of what is called coeliac disease among children, sprue among adults, need a diet free of those foods.

"A weakness in the immune system causes the membranes of the small intestine to become permeable to gluten," says Sofia Beisel, a nutritionist with the German Coeliac Society (DZG). The gluten eventually makes the intestine porous, preventing it from absorbing nutrients. Weight loss, diarrhea and malnutrition all combine to make the patient even weaker.

Joern Reckel, a general practitioner in Ahrensburg, says many people have a tendency to coeliac disease, but never suffer major problems, making a correct diagnosis among adults difficult, says Professor Joachim Moessner, director of the medical clinic at the University Clinic of Leipzig.

It only becomes serious when the patient suffers regular diarrhea, accompanied by weakness, weight loss and lack of energy. To diagnose the condition correctly, patients must undergo an intestinal endoscopy or an analysis of the intestinal tissue to find a certain blood-borne antibody. Reckel argues that people with sprue should be tested for other intolerances as the illness often indicates other microbiological disturbances.

Once diagnosed, a sufferer has to face a lifelong diet free of gluten. "That's a major change," says Beisel. While more and more gluten-free products can now be found in supermarkets, they are still more expensive than ordinary products. But cheating on the diet can have serious consequences, says Margret Marlo, a dietary assistant from Bocholt. These include lymphatic cancer in the small intestine.

Keeping to a strict diet helps the small intestine to regenerate, usually quite quickly. Then sufferers can carry on their lives with minimal risks and limitations.

(China Daily via DPA March 28, 2007)