Coeliac Disease - A condition that causes inflammation in the lining of the small
intestine (part of the gut).
The condition has several other names:
Non-tropical spruce.
Endemic spruce.
Gluten enteropathy.
Gluten-sensitive enteropathy.
Gluten intolerance.
The term coeliac derives from the Greek (koiliaküs, "abdominal"), and was introduced
in the 19th century in a translation of what is generally regarded as an ancient
Greek description of the disease by Aretaeus of Cappadocia.
Coeliac disease is not a food allergy or a food intolerance. It is an autoimmune
disease which means that the immune system (which normally protects the body) mistakenly
attacks itself.
Coeliac disease affects about 1/100 people in the UK.
The only known effective treatment is a lifelong gluten-free diet. While the disease
is caused by a reaction to wheat proteins, it is not the same as wheat allergy.
Anyone, at any age, can develop coeliac disease.
Affects women more frequently than men, at a ratio of 2:1.
Cause - A reaction to gliadin, a prolamin (gluten protein). Upon exposure to gliadin,
and certain other prolamins, the enzyme tissue transglutaminase modifies the protein,
and the immune system cross-reacts with the small-bowel tissue, causing an anti-inflammatory
reaction. those with coeliac disease make antibodies against gluten.
Antibodies are proteins in the immune system that normally attack bacteria, viruses,
and other germs In effect, the gut mistake's gluten to be harmful, and reacts against
it as if it were fighting off a germ. These antibodies lead to inflammation developing
in the lining of the small intestine. This leads to a truncating of the villi lining
the small intestine (villous atrophy) which interferes with the absorption of nutrients,
(intestinal villi are responsible for absorption).
Coeliac disease has been linked with a number of conditions. In many cases, it is
unclear whether the gluten-induced bowel disease is a causative factor or whether
these conditions share a common predisposition.
Occasionally, an itchy skin condition called dermatitis herpetiformis can occur in
some people with coeliac disease.
Those with coeliac disease have an increased risk of the following:
Developing osteoporosis (thinning of the bones) due to the nutritional deficiencies
which occur with coeliac disease.
Developing lymphoma (a type of cancer) of the gut in later life. This is rare though.
Developing other immune-related diseases (autoimmune diseases) such as type 1 diabetes,
an underactive thyroid, sjögren's syndrome and primary biliary cirrhosis.
Having a baby that has a low birth weight or is born prematurely if you become pregnant.
Having the disease can cause your spleen to work less effectively, making you more
vulnerable to infection from certain germs.
An increased risk of infections.
An increased risk of some autoimmune diseases.
Poor absorption of food may cause deficiencies of vitamins, iron, and other nutrients.
Anaemia due to poor absorption of iron is common.
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Infants -Symptoms of coeliac disease first develop soon after weaning as the infant
starts eating solid foods containing gluten:
The child may fail to grow or to gain weight.
The faeces (stools) may be pale and bulky.
Smelly diarrhoea may occur.
The abdomen (tummy) may become swollen.
The child may have repeated vomiting.
Older children..
The symptoms of coeliac disease in older children may be similar to those in babies.
Poor absorption of food may cause deficiencies of:
Vitamins.
Minerals
Other nutrients.
This may cause anaemia and other problems.
As the fat part of the diet is poorly absorbed, the faeces may become:
Pale.
Smelly.
Diarrhoea may develop.
The symptoms may not be very typical or obvious. If the gut and bowel symptoms are
only mild then the first thing that may be noticed is poor growth.
Adults.
Common symptoms include:
Abdominal pains which tend to - come and go.
Excess wind.
Bloating.
Diarrhoea.
Tiredness.
Weakness.
Mouth ulcers may occur.
Weight loss due to poor absorption of food. Most adults with coeliac disease may
not lose weight and are not normally found to be underweight.
Diagnosis
When the common symptoms described develop, the diagnosis may be made quickly. However,
common or typical symptoms are not always apparent, particularly in adults. The areas
affected in the gut may be patchy and symptoms may then be mild, or not typical,
and it may be a while before the diagnosis is made.
If coeliac disease is suspected, a blood test to detect a certain antibody that occurs
in coeliac disease may be advised, if the blood test is positive, then a biopsy may
be taken (a small sample of tissue is taken from the inside lining of the small intestine),
and other tests may be done to find out to what degree poor absorption of nutrients
may have affected the body.
Do not treat self-treat by going on a gluten-free diet without a confirmed diagnosis.
If you do go on a gluten-free diet before the diagnosis is confirmed, then any tests
done at a later time may not be conclusive and may even provide negative results.
The condition used to be associated with young children. However, it is now much
more commonly diagnosed in adults, and is most commonly diagnosed in those aged between
40 and 50. About 1 in 4 cases are first diagnosed in those aged over 60.
Coeliac disease often runs in families. If there is a close family member who has
coeliac disease (a brother, sister, parent or child) then there is a 1 in 10 chance
of having coeliac disease.
Coeliac disease can develop in babies. Older children or adults who have not previously
had problems may also become gluten sensitive at some point in their life and develop
coeliac disease.
It is not known why the immune system becomes sensitised to gluten.
