Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an auto-immune disorder, triggered by gluten protein found in wheat, barley, oats and rye.

The body produces antibodies against gluten which can cause a series of gastrointestinal symptoms. Coeliac disease is a lifelong disorder.

Who does Coeliac Disease Affect?

Coeliac disease affects 1 in every 100-300 individuals. It can appear at any age, with peaks in childhood and for adults above 50 years old.

Coeliac disease is more prevalent in women as compared to men and first degree relatives are more likely to have it as well.

How does Coeliac Disease Occur?

Coeliac disease occurs due to an abnormal response of the body’s immune system to the gluten protein present in everyday food items.

The body’s T-cells attack the small intestine cells causing inflammation and a loss of your microscopic intestinal tentacles (villi). These hair-like projections or villi are responsible for absorbing all the nutrients and vitamins from the food.

Villous atrophy is what causes Coeliac disease symptoms. This damage to the intestines also leads to fatigue.

Causes of Coeliac Disease

While there is a genetic component to the coeliac disease, as well as eating gluten-containing foods, the exact causes of the coeliac disease have not been confirmed.

In addition to genetic susceptibility, an allergy to gluten can also be triggered by moments of severe physical or emotional stress, such as surgery, childbirth, an infection or a severe emotional dilemma.

Symptoms of Coeliac Disease

The symptoms of coeliac disease can occur on their own or appear with symptoms of another disorder.

They often mimic the signs of Irritable Bowel Syndrome (IBS). The patient may complain of:

Abdominal pain or discomfort
Diarrhoea
Floating stools (steatorrhea) / stinking stools
Feeling of bloating, ‘unable to pass gas’
Weight loss
A feeling of lethargy and weakness
Osteomalacia
In children, there is also a failure to thrive

Types of Coeliac Disease

There are three main types of coeliac disease based on the symptoms experienced.

Classic – Develops in childhood and in adults, exhibits all the usual associated symptoms,
Atypical or non-classic – Disease presents itself without common small bowel symptoms and presents with chronic fatigue, migraine, peripheral neuropathy and anemia,
Asymptomatic (Silent) – This type presents itself without any signs of coeliac disease or any small bowel issues. The patient experiences edema (oedema), joint pain and migraines.

Stages of Coeliac Disease

There are no stages, but the severity of the symptoms is gradient and depends on the amount of gluten in the diet.

The symptoms will be proportionally severe to higher ingestion of gluten-containing products.

How is Coeliac Disease Diagnosed?

The diagnosis for coeliac disease is made by taking a complete history, physical examination and lab investigations.

The doctor may order certain lab tests including:

serology labs to test for the presence of specific antibodies, and
genetic testing for HLA-DQ2 and HLA-DQ8 genes, which are associated with coeliac disease.

The disease is confirmed by performing a duodenal biopsy to observe villous changes and intestinal inflammation.

How is Coeliac Disease Treated?

Coeliac disease is treated by switching to a gluten-free diet, for life.

Gluten-free flour, bread, pasta and biscuits are readily available in most places. Dietary substitution with rice, soy, corn, sugar and potatoes will work.

Once the gluten has cleared the patient’s system, the symptoms subside with time and eventually stop.

The doctor can monitor progress by re-examination and repeating lab tests. If the symptoms are very severe, steroids may be prescribed to control the symptoms and multi-vitamins would be given to treat malnutrition.