Coeliac disease is a long-term autoimmune condition in which eating gluten causes the immune system to damage the lining of the small intestine. Gluten is found in wheat, barley, and rye. In people with coeliac disease, exposure to gluten can lead to poor nutrient absorption and symptoms affecting the gut, skin, blood, bones, nerves, fertility, or general health.
Mechanism
In coeliac disease, the immune system reacts abnormally to gluten. The reaction damages villi, the small finger-like structures that line the small intestine and help absorb nutrients.
When villi are damaged, the body may absorb less iron, folate, vitamin B12, calcium, vitamin D, and other nutrients. This is why coeliac disease can present with problems outside the digestive system, including anaemia, tiredness, bone thinning, mouth ulcers, neurological symptoms, or delayed growth in children.
Coeliac disease is not the same as a wheat allergy or non-coeliac gluten sensitivity. It is an autoimmune disease with specific immune and intestinal findings.
Symptoms
Symptoms vary. Some people have severe digestive symptoms. Others have mild symptoms or are diagnosed after blood tests show nutrient deficiency.
Digestive symptoms can include:
- Diarrhoea.
- Abdominal pain.
- Bloating and wind.
- Constipation.
- Indigestion.
- Nausea or poor appetite.
- Weight loss or difficulty gaining weight.
Other features can include:
- Tiredness.
- Iron deficiency anaemia or vitamin B12 and folate deficiency anaemia.
- Mouth ulcers.
- Itchy blistering rash, known as dermatitis herpetiformis.
- Bone or joint pain.
- Osteoporosis or low bone density.
- Peripheral neuropathy, balance problems, or ataxia.
- Fertility problems or pregnancy complications.
- Delayed growth or delayed puberty in children.
Risk Factors
Coeliac disease can occur at any age. NHS material describes it as affecting at least 1 in 100 people in the UK, although milder cases may be missed.
Risk is higher in:
- First-degree relatives of someone with coeliac disease.
- People with type 1 diabetes.
- People with autoimmune thyroid disease.
- People with Down's syndrome or Turner syndrome.
- People with unexplained iron deficiency anaemia, persistent digestive symptoms, or dermatitis herpetiformis.
Diagnosis
Diagnosis usually starts with blood tests for antibodies linked with coeliac disease. If the blood tests are positive, referral to a gastroenterologist and small-intestine biopsy may be used to confirm the diagnosis.
The person being tested normally needs to be eating gluten before and during testing. Starting a gluten-free diet before testing can reduce antibody levels and make results harder to interpret.
After diagnosis, additional tests may check for nutritional effects, such as iron deficiency, folate deficiency, vitamin B12 deficiency, vitamin D deficiency, or low bone density.
Treatment
The main treatment is a lifelong gluten-free diet. This means avoiding foods and drinks containing wheat, barley, and rye, and using gluten-free alternatives where needed.
Foods that often contain gluten include:
- Bread, pasta, cakes, pastries, and many breakfast cereals.
- Some sauces, gravies, ready meals, coatings, and processed foods.
- Many beers and malt-containing drinks.
Oats do not naturally contain the same gluten proteins as wheat, barley, and rye, but they are often contaminated during processing. Many people with coeliac disease use only oats labelled gluten-free, and some need specialist advice because oats can still cause symptoms in a minority of cases.
Dietetic support is important because a gluten-free diet must still provide enough fibre, iron, calcium, folate, and other nutrients. Food labels, shared kitchens, eating out, and cross-contact are common practical issues.
Complications
Untreated or poorly controlled coeliac disease can lead to ongoing symptoms and long-term complications. These can include:
- Iron deficiency anaemia.
- Vitamin B12 or folate deficiency anaemia.
- Osteoporosis or increased fracture risk.
- Malnutrition and weight loss.
- Poor growth or delayed puberty in children.
- Fertility problems or pregnancy complications.
- Dermatitis herpetiformis.
- Rare intestinal cancers, particularly in long-standing untreated disease.
Most people improve on a strict gluten-free diet, but recovery of the intestine can take time. Persistent symptoms may be caused by accidental gluten exposure, another digestive condition, or, rarely, refractory coeliac disease.
See Also
References
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