COELIAC DISEASE - a patient's guide
Editorial Team

Overview

Coeliac disease is an inflammatory disease of the small bowel triggered by sensitivity to gluten found in wheat and other cereals.

The illness prevents absorption of crucial nutrients, for example iron, causing anaemia.

Calcium, folic acid and fat soluble vitamins may not be absorbed.

The disease may cause diarrhoea, vomiting and lead to weight loss and ill health.

Increasingly, milder forms with fewer overt symptoms are being recognised.

The condition resolves with the introduction of a gluten-free diet.

Rice, corn, soy, buckwheat and arrowroot form part of a gluten-free diet.

There is debate over whether oats cause symptoms, but recent evidence suggests they don't.

A proper diagnosis is needed before a strict diet is adopted.

Many people are not diagnosed until adulthood (average age in 40s).

Breast feeding and late introduction of wheat to babies diets may help prevent it.

What is it?

Coeliac disease (also known as gluten-sensitive enteropathy, gluten allergy, and coeliac sprue) is an illness caused by intolerance to gluten which is found in wheat and similar proteins in rye and barley.

It is not an allergy but eating foods which contain gluten can upset and inflame the small intestine, preventing the digestion of crucial nutrients.

Sufferers fail to digest and absorb their food properly, leading to weight loss and failure to thrive.

The incidence ranges from country to country. With the advent of new tests, it is now recognised that it is perhaps much more common than previously thought and may affect 1 in 200 individuals.

Evidence suggests that hereditary factors play an important role with up to 10 % of first degree relatives affected. However only 60-70% of identical twins are affected, suggesting other factors like infections may play a role in triggering it.

Many foods contain gluten including wheat, bran, flour, cereal, rye, barley, durum, burghul, triticale, spelt, farina, semolina, starch, oats, pasta, noodles, vermicelli, bread crumbs, liquorice, and couscous.

What are the symptoms?

Note: many patients, particularly in adulthood, may have minimal symptoms.

Reactions to gluten include indigestion, diarrhoea, vomiting, headaches, coughing and wheezing.

A skin condition that causes blistering rash is also linked to coeliac disease (dermatitis herpetiformis).

The problem can appear at any age and is often not diagnosed until adulthood.

Symptoms in adults include bloating, wind, diarrhoea, and indigestion.

Children normally show signs before the age of two. They may have failed to thrive after the introduction of wheat to their diet, and show signs of regular stomach pain, persisting diarrhoea and irritability.

In some cases growth failure may not happen for many years and only comes to light in teenage years with delayed puberty.

Some people with the condition may not have intestinal problems. The only indication may be iron or folic acid deficiency, and anaemia.

The condition can be hard to diagnose because of the difficulty in identifying foods that could be responsible. A reaction may only happen hours after eating.

Blood tests may show anaemia resulting from lack of absorption of essential nutrients.

A screening antibody test (endomysial antibody) is available to help diagnose the condition, but this should not be relied solely upon for a diagnosis.

This test has helped greatly with diagnosing and monitoring the response to treatment.

A small bowel biopsy is necessary for a definite diagnosis, followed by a gluten-free diet, and then another small bowel biopsy six months later to show an improvement in the condition.

Bowel biopsy shows a characteristic damage to the lining of the bowel called villous atrophy. This may take months to reverse after a gluten free diet is started.

In practice, a second biopsy may not be needed if there is a good response to withdrawing gluten.

Children of people with the disease should be tested for the condition, because up to 10 percent of first degree relatives will also have coeliac disease.

Prognosis and complications

If a gluten free diet is followed, the outlook is excellent and good health should be achieved.

Failure to adhere to a strict gluten-free diet may result in ongoing symptoms and an increased risk of certain bowel cancers (small intestinal and oesophageal cancers). Adhering to a strict gluten free diet protects against these malignancies.

Another important long term risk is osteoporosis (thinning of bones) and patients should be checked and treated for this.

What can be done?

A life-long gluten-free diet is necessary for people with coeliac disease.

This may be very difficult to achieve and sustain, as gluten is present in so many foods. The support and guidance of a good dietitian is extremely helpful.

Improvement is generally noticed after one to two weeks on a gluten-free diet. Changes in the lining of the bowel may take months or years.

Compliance with diet may be monitored by regular antibody tests (antigliandin and antiendomyosial antibodies).

People with coeliac disease must be extremely careful about what they eat and to check packaging for any signs of ingredients which may contain gluten.

Sausages, soups and pastries may also have to be ruled out of the diet.

Rice, corn, soy, millet, buckwheat, arrowroot are the mainstay of a gluten-free diet.

Other gluten-free products include sago, chickpea flour, cornmeal, cider, glucose syrup, topiaco, rapeseed, and modified maize starch.

There is continued debate over whether oats produce symptoms in people with coeliac disease. Oats have been ruled out of the diet in the past but recent studies have shown they do not cause symptoms.

Young children on restricted diets may need vitamin supplements.

Patients with coeliac disease should be seen by a doctor at least once a year for a medical check-up.

How can it be prevented?

Coeliac disease is believed to be inherited in some cases. But the early introduction of wheat to babies diets could also be to blame.

Breast feeding and introducing wheat to babies diets at a late stage are thought to protect against coeliac disease.

Do not adopt a strict diet without tests to confirm coeliac disease.

Future trends

Research into what triggers the illness to develop.

Diagnosing milder cases earlier using antibody tests.

Getting help?

Your doctor or dietitian will be able to help.