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	'''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.

Celiac disease, also known as coeliac disease, is a chronic autoimmune disorder characterized by an immune reaction to the ingestion of gluten. Gluten is a mixture of proteins found in wheat, barley, rye, and their derivatives. The ingestion of gluten triggers an immune response in individuals with celiac disease, leading to damage in the small intestine and various associated symptoms.
	== 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.

== Overview ==
Celiac disease is a complex condition that affects the small intestine, impairing its ability to properly absorb nutrients from food. When individuals with celiac disease consume gluten, the immune system responds by attacking the lining of the small intestine. Over time, this immune reaction causes damage to the intestinal villi, small finger-like projections responsible for nutrient absorption.
	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\|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 ==
The symptoms of celiac disease can vary widely among affected individuals. Some individuals may experience severe symptoms, while others may have milder or even no apparent symptoms. Common symptoms of celiac disease include:
	Symptoms vary. Some people have severe digestive symptoms. Others have mild symptoms or are diagnosed after blood tests show nutrient deficiency.

* Digestive issues, such as abdominal pain, bloating, diarrhea, or constipation
* Weight loss or failure to thrive (in children)
* Fatigue and weakness
* [[Anemia]] (low red blood cell count)
* Bone or joint pain
* Skin rash ([[dermatitis herpetiformis]])
* Dental enamel defects
* Depression or anxiety
	Digestive symptoms can include:

It is important to note that symptoms can occur at any age, from early childhood to adulthood.
	* 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 ==
Diagnosing celiac disease involves a combination of medical evaluations, including:
	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.

# Medical History: A comprehensive review of the patient's medical history, including symptoms, family history, and response to dietary changes.
# Blood Tests: Blood tests are conducted to measure certain antibodies commonly found in individuals with celiac disease. These include anti-tissue transglutaminase (tTG) antibodies and anti-endomysial (EMA) antibodies.
# Small Intestinal Biopsy: If blood tests suggest celiac disease, a small intestinal biopsy may be performed. During this procedure, a small tissue sample is taken from the small intestine to evaluate the extent of damage to the intestinal villi.
# Genetic Testing: Genetic testing may be used to identify certain genetic markers associated with celiac disease, specifically the human leukocyte antigen (HLA) genes.
	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.

It is important for individuals suspected of having celiac disease to continue consuming gluten-containing foods until all diagnostic tests are completed to ensure accurate results.
	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 and Management ==
The only effective treatment for celiac disease is a lifelong adherence to a strict gluten-free diet. This involves the complete elimination of gluten from the diet, including all foods and beverages that contain wheat, barley, rye, and their derivatives. Even small amounts of gluten can trigger an immune response and cause intestinal damage.
	== 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.

Individuals with celiac disease must carefully read food labels, be aware of hidden sources of gluten, and adopt gluten-free alternatives. Gluten-free grains and flours, such as rice, corn, quinoa, and millet, are safe to consume. A gluten-free diet allows the intestinal villi to heal and promotes overall health and well-being.
	Foods that often contain gluten include:

== Complications and Associated Conditions ==
If left untreated, celiac disease can lead to several complications and associated conditions, including:
	* Bread, pasta, cakes, pastries, and many breakfast cereals.
	* Some sauces, gravies, ready meals, coatings, and processed foods.
	* Many beers and malt-containing drinks.

* Malabsorption: Damage to the small intestine can impair nutrient absorption, leading to malnutrition, vitamin and mineral deficiencies, and other related health issues.
* Osteoporosis: Reduced calcium absorption can result in weak and brittle bones, increasing the risk of fractures.
* Infertility and Pregnancy Complications: Untreated celiac disease may contribute to fertility problems and increase the risk of miscarriage, preterm birth, and other complications during pregnancy.
* Other Autoimmune Disorders: Individuals with celiac disease have an increased risk of developing other autoimmune conditions, such as type 1 diabetes, autoimmune thyroid disease, and autoimmune liver disease.
* Intestinal Lymphoma: Rarely, long-standing untreated celiac disease can lead to the development of intestinal lymphoma, a type of cancer.
	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.

Regular follow-up care, adherence to a gluten-free diet, and monitoring of nutrient levels are important in managing celiac disease and minimizing associated risks.
	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.

== Gluten-Free Living ==
The adoption of a gluten-free lifestyle goes beyond dietary changes. It often requires individuals with celiac disease to be mindful of gluten in various aspects of their lives, including personal care products, medications, and cross-contamination in food preparation. Education, support from healthcare professionals, and engaging with celiac disease communities can provide valuable guidance and resources for successful gluten-free living.
	== 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 ==	== See Also ==
	* [[Autoimmune Disorders]]
	* [[Anaemia]]
	* [[Gluten-Free Foods]]
	* [[Type 1 Diabetes]]

* [[Gluten-Free Foods]] - Explore the range of products and dietary choices for individuals following a gluten-free lifestyle.
* [[Gluten Sensitivity]] - Learn about a non-celiac condition characterized by adverse reactions to gluten ingestion.
* [[Autoimmune Disorders]] - Discover a group of conditions where the immune system mistakenly attacks healthy body tissues.
	== References ==
	* [https://www.nhs.uk/conditions/coeliac-disease/ NHS: Coeliac disease overview]
	* [https://www.nhs.uk/conditions/coeliac-disease/diagnosis/ NHS: Coeliac disease diagnosis]
	* [https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/coeliac-disease/coeliac-disease/ NHS inform: Coeliac disease]
	* [https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment NIDDK: Treatment for celiac disease]

	[[Category:Medicine]]
	[[Category:Autoimmune Disorders]]
	[[Category:Gastroenterology]]