Coeliac Disease

Overview

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Coeliac disease is a chronic autoimmune disorder where ingestion of gluten (a protein found in wheat, barley, and rye) leads to damage in the small intestine. It affects the digestive system and can cause a variety of symptoms and long-term complications if untreated.

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Symptoms

Coeliac Disease Symptoms Vary Greatly, Ranging from dIgestive Issues to More Generalized or Systemic Problems. Some Individuals may be Asymptomatic.

Non-digestive Symptoms

  • Fatigue
  • Weight loss or inability to gain weight
  • Anemia (often iron-deficiency)
  • Joint pain or stiffness
  • Osteoporosis or osteopenia
  • Depression or anxiety
  • Skin rashes (dermatitis herpetiformis)
  • Mouth ulcers
  • Numbness or tingling in hands and feet
  • Delayed growth in children
  • Infertility or recurrent miscarriages

Digestive Symptoms

  • Diarrhea
  • Bloating and gas
  • Abdominal pain or cramping
  • Constipation
  • Nausea and vomiting
  • Foul-smelling or fatty stools (steatorrhea)
Complications

If Left Untreated, Coeliac Disease can Lead to Serious Complications

  • Malnutrition: Damaged villi in the small intestine cause nutrient malabsorption, leading to deficiencies.
  • Osteoporosis and Osteomalacia: Due to poor absorption of calcium and vitamin D.
  • Infertility or Miscarriage: Especially in women.
  • Lactose Intolerance: Intestinal damage may reduce lactase production, leading to temporary lactose Intolerance.
  • Cancer: Increased risk of small bowel cancers and intestinal lymphoma.
  • Neurological Problems: Seizures or peripheral neuropathy (nerve damage in hands and feet).
Causes
  • The exact cause of coeliac disease is unknown, but it involves a combination of genetic predisposition and environmental triggers.
  • Genetics: Individuals with certain genetic markers (HLA-DQ2 or HLA-DQ8) are more likely to develop coeliac disease.
  • Gluten: Eating foods that contain gluten triggers an immune response in genetically predisposed people.
  • Immune Response: The immune system attacks the lining of the small intestine, damaging the villi (tiny hair-like projections that absorb nutrients).
Prevention

Currently, there is no way to prevent coeliac disease in people who are genetically predisposed. However, early diagnosis and a strict gluten-free diet can prevent complications.

Risk Factors

Several Factors Increase the Risk of Developing Coeliac Disease

  • Family History: First-degree relatives of individuals with coeliac disease are at a higher risk.
  • Autoimmune Disorders: Such as type 1 diabetes, autoimmune thyroid disease, Addison’s disease, and autoimmune hepatitis.
  • Genetic Disorders: People with Down syndrome or Turner syndrome have a higher prevalence of coeliac disease.
  • Other Conditions: Such as IgA deficiency and rheumatoid arthritis."

How is it Treated?

The only effective treatment for coeliac disease is a strict lifelong gluten-free diet. This allows the small intestine to heal, alleviates symptoms, and prevents further damage and complications.

Dietary Management

  • Eliminate all sources of gluten (found in wheat, rye, and barley) from the diet.
  • Replace with gluten-free grains such as rice, quinoa, and gluten-free oats.
  • Read food labels carefully and avoid processed foods that may contain hidden gluten.
  • Work with a dietitian to ensure balanced nutrition.
  • Supplements: In the initial stages, supplements may be necessary to correct deficiencies (e.g., iron, calcium, vitamin D, B12, folate).
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How is it Diagnosed?

Coeliac disease is diagnosed through a combination of clinical evaluation, serological testing, and intestinal biopsy. It is an autoimmune disorder triggered by the ingestion of gluten in genetically predisposed individuals.

Initial diagnosis begins with a detailed medical history focusing on gastrointestinal symptoms such as chronic diarrhea, bloating, weight loss, fatigue, and anemia. Non-GI symptoms like dermatitis herpetiformis, infertility, or neurological complaints may also prompt investigation.

    The primary screening tests are serologic blood tests, including:

  • Tissue transglutaminase antibody (tTG-IgA) – the most sensitive and specific test.
  • Total serum IgA – to rule out IgA deficiency, which can lead to false-negative results.
  • Endomysial antibody (EMA) and deamidated gliadin peptide (DGP) may also be used for confirmation.
  • If serology is positive, the next step is an upper gastrointestinal endoscopy with biopsy of the small intestine (usually the duodenum). Histopathological findings such as villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes confirm the diagnosis.
  • Genetic testing for HLA-DQ2 or HLA-DQ8 alleles may be done in equivocal cases. Although not diagnostic on their own, absence of these alleles can rule out coeliac disease.
  • It is important that patients continue to consume gluten before testing, as a gluten-free diet can cause false-negative results. Early diagnosis is vital to prevent complications like malnutrition, osteoporosis, and small bowel malignancy.

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FAQs

Yes, coeliac disease can be diagnosed at any age. Some people may not develop symptoms until later in adulthood.

No, even small amounts of gluten can cause damage to the intestine and trigger symptoms in people with coeliac disease.

There is currently no cure. The only treatment is a lifelong adherence to a gluten-free diet.

Yes, some individuals may have no symptoms but still experience intestinal damage, which can lead to complications if untreated.

No, gluten intolerance (non-coeliac gluten sensitivity) does not cause the immune response or intestinal damage seen in coeliac disease.

Yes, even trace amounts of gluten through cross-contamination can cause symptoms and intestinal damage in individuals with coeliac disease.

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