Practice A Patient’s Journey

Coeliac disease and a gluten-free diet

BMJ 2009; 338 doi: (Published 19 February 2009) Cite this as: BMJ 2009;338:b380
  1. Jocelyn Anne Silvester, patient1,
  2. Mohsin Rashid, gastroenterologist2
  1. 1 Winnipeg, Manitoba, Canada R3N 1B2,
  2. 2Division of Gastroenterology, Department of Paediatrics, Faculty of Medicine, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada B3K 6R8
  1. Correspondence to: M Rashid mohsin.rashid{at}
  • Accepted 26 November 2008

A woman who had symptoms of coeliac disease from childhood describes how her life improved markedly once the disease was diagnosed­ in her 20s

The day my physician gave me the most powerful tool that doctors have—a diagnosis—marked the point when my journey living with coeliac disease began. For years I had had chronic abdominal pain and vague gastrointestinal symptoms. As a child, I never slept on my stomach because it was always sore. When I was a teenager, my symptoms worsened (possibly related to an increasing reliance on pizzas). I was generally unwell and developed a chronic iron deficiency anaemia that was refractory to oral iron supplements. My physicians—general practitioners and gastroenterologists—would take a history then prescribe a therapeutic dose of barium (to both ends) to reassure themselves that they had not missed a diagnosis of inflammatory bowel disease.

As the barium cycle was repeated, I realised that medicine is the art not of making a diagnosis but of ruling one out, with special attention to the rare and deadly (I was once screened for acute intermittent porphyria). Once all medical diagnoses had been ruled out, two areas remained—functional and psychiatric disorders. My insistence that my symptoms did not fit with a functional disorder only seemed to increase my physicians’ conviction that I had a psychiatric disorder. As my symptoms persisted, frustration was mutual, and I became a “heartsink patient.”

On the road to a diagnosis

My inspiration for considering the diagnosis of coeliac disease came when I was studying in Scotland. At that time, cheap bread and breakfast cereals had become my staples, and my symptoms had worsened. …

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