CONDITIONS
Coeliac disease
What is coeliac disease?
Coeliac disease is a condition where the immune system attacks the body’s own tissues when gluten is consumed, damaging the mucous membrane lining of the small intestine and preventing the body from effectively absorbing nutrients. Gluten is a protein in food containing wheat, barley, or rye.
If one has coeliac disease, eating gluten triggers an immune response to the gluten protein in the small intestine. Over time, this reaction damages the small intestine’s lining and prevents it from absorbing nutrients, a condition called malabsorption. The intestinal damage often causes symptoms such as diarrhoea, fatigue, weight loss, bloating, or anaemia. It also can lead to serious complications if not managed or treated. In children, malabsorption can affect growth and development in addition to gastrointestinal symptoms.
What happens when individuals with coeliac disease consume gluten?
Gluten is a protein found in wheat, rye, and barley and in products made from these ingredients, such as bread, pasta, and biscuits. Individuals with coeliac disease produce antibodies against gluten, which are proteins in the immune system that typically target bacteria, viruses, and other pathogens. The immune system mistakenly identifies gluten as harmful, leading to an immune response like fighting off an infection. This immune response causes inflammation in the gut lining and damages the villi (hair-like projections that line the intestines), impairing its function. The damaged villi can hinder the absorption of nutrients from food, leading to malabsorption.
Coeliac disease can develop in infants, and older children or adults who have not previously experienced issues may also develop gluten sensitivity and coeliac disease later in life. The reason why some individuals’ immune systems become sensitized to gluten is not fully understood.
When does coeliac disease develop?
Coeliac disease can manifest at any point in life after the person or child starts consuming gluten. Doctors frequently observe it during two specific age ranges: early childhood, typically between 8 and 12 months old, and middle age, between 40 and 60 years old. The early childhood period is usually when children start consuming solid foods that may contain gluten, such as cereals or biscuits.
What are the symptoms of coeliac disease?
The symptoms of coeliac disease can vary greatly, with differences often seen between children and adults. Digestive symptoms in adults may include:
- Weight loss.
- Bloating and gas.
- Abdominal pain.
- Nausea and vomiting.
Other symptoms of coeliac disease which are not related to the digestive system include
- Iron deficiency anaemia
- Itchy, blistery skin rash called dermatitis herpetiformis.
- Loss of bone density, called osteoporosis, or softening of bones, called osteomalacia.
- Mouth ulcers.
- Headaches or migraines.
- Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment.
- Joint pain.
- Reduced functioning of the spleen, known as hyposplenism.
- Elevated liver enzymes.
- Weight loss
Digestive symptoms are more common in children and infants. The most common symptoms found in children are:
- Nausea and vomiting.
- Chronic diarrhoea.
- Abdominal bloating and pain.
- Constipation
- Gas
- Pale, foul-smelling stools.
Inadequate nutrient absorption can lead to:
- Poor growth in infants.
- Tooth enamel erosion.
- Decreased body weight.
- Low red blood cell count.
- Restlessness
- Reduced height.
- Late onset of puberty.
- Nervous system issues such as attention-deficit/hyperactivity disorder (ADHD), learning disabilities, migraines, and muscle weakness.
What are the different types of coeliac diseases?
There are three common types of coeliac disease: classical, non-classical, and silent coeliac disease.
- In the case of classical coeliac disease, individuals exhibit symptoms of malabsorption, such as diarrhoea, steatorrhea, and weight loss or growth issues in children.
- In non-classical coeliac disease, individuals may present with mild gastrointestinal symptoms without experiencing symptoms of malabsorption. They may have issues like abdominal pain, iron-deficiency anaemia, chronic fatigue, peripheral neuropathy, elevated liver enzymes, reduced bone mass, vitamin deficiencies, difficulty losing weight, menstrual irregularities, infertility, dental problems, depression, anxiety, and itchy skin rash (dermatitis herpetiformis).
- Silent coeliac disease, also referred to as asymptomatic coeliac disease, is characterized by the absence of symptoms in patients despite having damage to villi in small intestine.
How is coeliac disease diagnosed?
A diagnosis is made through a physical examination and medical history. Doctors will conduct various tests to confirm the diagnosis. Coeliac disease patients often have elevated levels of Antiendomysium (EMA) and anti-tissue transglutaminase (TGA) antibodies, which can be detected through blood testing. These tests are most accurate when gluten is still part of the diet.
Standard blood tests include:
- Complete blood count (CBC)
- Liver function tests
- Cholesterol test
- Alkaline phosphatase level test
- Serum albumin test
In cases of dermatitis, a skin biopsy can help detect coeliac disease. If the skin biopsy and blood tests indicate coeliac disease, an internal biopsy may not be necessary.
When blood tests or skin biopsies are inconclusive, an upper endoscopy can be used to diagnose coeliac disease. This procedure involves inserting an endoscope through the mouth and into the small intestines to examine for villi damage. An intestinal biopsy may also be performed during this procedure for further analysis. An intestinal (duodenal) biopsy is considered the “gold standard” for diagnosis because it will determine 1) if coeliac disease is present, 2) if symptoms improve on a gluten-free diet or 3) if a different gastrointestinal disorder or sensitivity is present that responds to dietary changes.
What is the treatment for coeliac disease?
The only way to treat coeliac disease is by eliminating gluten from the diet. This will help the intestinal villi to heal and properly absorb nutrients again. Individuals will receive instructions from their doctor on removing gluten from their diet while maintaining a healthy and nutritious eating plan. They will also be taught how to read food and product labels to identify any gluten-containing ingredients.
Further treatment options may consist of:
- Nutritional supplements to address any significant deficiencies.
- Specific medications like dapsone to manage dermatitis herpetiformis.
- Corticosteroids for severe inflammation that is not improving quickly with dietary changes.
- Ongoing monitoring and follow-up care may involve regular testing to ensure the disease is being managed effectively.
In summary, coeliac disease, also known as coeliac sprue, nontropical sprue, or gluten-sensitive enteropathy, is an autoimmune disorder triggered by the consumption of gluten. Individuals with coeliac disease experience adverse reactions to the protein, resulting in harm to the villi in their small intestine. Damaged villi hinder the absorption of nutrients from food, potentially leading to malnourishment, decreased bone density, infertility, miscarriage, neurological issues. Regular check-ups may be required to confirm that the illness is being properly controlled through ongoing monitoring and follow-up care.
References
- Overview Coeliac disease. Available from: https://www.nhs.uk/conditions/coeliac-disease/#:~:text=Coeliac%20disease%20is%20a%20condition,diarrhoea%2C%20abdominal%20pain%20and%20bloating. Accessed on May 13th, 2024.
- Mayo Clinic. Coeliac disease. Available from: https://www.mayoclinic.org/diseases-conditions/coeliac-disease/symptoms-causes/syc-20352220. Accessed on May 13th, 2024.
- Coeliac Disease Foundation. Symptoms of Coeliac disease. Available from: https://coeliac.org/about-coeliac-disease/symptoms-of-coeliac-disease/. Accessed on May 13th, 2024.
- Cleveland Clinic. Coeliac Disease. Available from: https://my.clevelandclinic.org/health/diseases/14240-coeliac-disease. Accessed on May 13th, 2024.
