What is coeliac disease?
Coeliac disease (also known as gluten-sensitive enteropathy) is an immune-mediated disorder, whereby the immune system causes damage to the small bowel when affected people eat gluten (a protein in some grains such as wheat, barley, and rye). It occurs in approximately 1 in 100 people.
What cause coeliac disease?
When people with coeliac disease eat foods that contain gluten, their immune system damages the lining of the intestine. This causes changes to the villi, the hair like structures that line the small intestine. This decreases the area that the nutrients can be absorbed by these villi.
What are the symptoms of coeliac disease?
Symptoms vary among sufferers and include:
- No symptoms at all
- Fatigue (lack of energy)
- Digestive problems such as abdominal bloating, increased wind, pain, diarrhoea, constipation, pale stools and weight loss
- Skin rash
- Mouth ulcers
- Unexplained anaemia (low blood count)
- Musculoskeletal symptoms such as joint pain
- Growth problems and failure to thrive (in children). This is because they cannot absorb the nutrients
What other health problems can accompany coeliac disease?
Coeliac disease can leave the patient vunerable to other health problems, including
- Osteoporosis (weakened bones that are more prone to fractures)
- Cancer of the intestine (very rare)
How is coeliac disease diagnosed?
If your doctor thinks that you might have coeliac disease, they will perform a careful history and examination. They will ask for a blood test to measure antibodies to gluten. Sometimes a genetic test for coeliac disease may be necessary.
The best test for coeliac disease is a biopsy of your small intestine to check for damage to the villi. This is performed by something called a gastroscopy.
How is coeliac disease treated?
It is treated through having a gluten free diet. That is, all foods with wheat, barley and rye need to be excluded from the diet. You will be encouraged to visit a dietician for formal diet education. Dropping gluten from the diet usually improves the condition within a few days and eventually ends the symptoms of the disease. The villi usually require months to completely heal.
You will need regular follow-up visits and have to remain on the gluten free diet for the rest of tour life. Eating even a small amount of gluten can cause damage.
Following a gluten-free diet means you cannot eat many "staples," including cereals, pasta, and many processed foods that contain gluten. There may also be gluten in ingredients added to food to improve texture or flavour and in some medicines. Some less obvious sources of gluten may include ice cream and salad dressing. Cross-contamination is another common source of gluten which happens when gluten-free foods come accidentally into contact with gluten.
If you have coeliac disease, you can still eat a well-balanced diet. For instance, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available. Food companies and some grocery stores also carry gluten-free bread and products.
You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats and fish, since these do not contain gluten.
How can I prevent coeliac disease?
Coeliac disease cannot be prevented. Early detection and management of coeliac disease may prevent complications. Therefore, it is very important to check for coeliac disease in persons at higher risk for having the condition, such as first-degree family members of patients with coeliac disease.