Coeliac disease

Coeliac disease (also known as celiac disease) is an inflammatory condition caused by sensitivity to the protein gluten, which is found in wheat, rye and barley. The condition is very common but symptoms can be kept under control with a strict gluten-free diet.

In people with coeliac disease, the body treats gluten as harmful and attacks it, so that the lining of the small intestine is damaged. The finger-like projections (villi), which increase the absorptive surface area of the small intestine, are partially or totally flattened. This means that the body is not able to absorb as many nutrients, including vitamins and minerals and leads to diarrhoea and malnutrition.

Coeliac disease affects about 1 in 100 people in the UK, although some may have minimal or no symptoms (known as silent coeliac disease). Research suggests that many of those who have coeliac disease will not have been diagnosed. Coeliac disease affects both adults and children and runs in families.

Sensitivity to gluten is the cause of coeliac disease and this often runs in families, suggesting a genetic link.

Severe stress, physical injury, infection, pregnancy, childbirth or surgery may lead to symptoms developing.

It is also more common in people with insulin dependent diabetes and autoimmune thyroid disease.

The severity of the disease varies and some people never develop symptoms. The condition may be diagnosed when relatives with coeliac disease are being studied.

In babies, the symptoms of coeliac disease first appear soon after cereals are introduced into the diet.

They include:

- Bulky and pale stools,
- Smelly diarrhoea,
- Vomiting,
- Failure to gain weight,
- A swollen abdomen,
- Muscle wasting, and
- An itchy rash on the knees, buttocks, elbows and shoulders.

In children, poor growth can be a symptom of coeliac disease. Anaemia may be diagnosed after the age of three or four years, due to insufficient vitamins and minerals being processed by the body.

The symptoms in adults develop gradually and include:

- Diarrhoea,
- Tiredness and breathlessness,
- Mouth ulcers,
- Weight loss,
- Vomiting,
- Anaemia, and
- Abdominal pain.

Some patients develop a chronic, distinctive rash called dermatitis herpetiformis.

There is a risk of developing osteoporosis in later life and in rare/severe cases infertility or cancer of the small intestine.

In babies, coeliac disease can be diagnosed if symptoms developed soon after solid foods were introduced.

In an adult, diagnosis is based on symptoms and a specialised blood test. A biopsy confirms the diagnosis; this involves removing and examining a small sample of tissue from the lining of the small intestine.

Gluten as a protein is not essential to the diet and can be replaced by other foods.

Coeliac disease can be kept under control and further problems prevented by completely eliminating gluten and related proteins from the diet. Supplements of vitamins and minerals may also need to be taken for a short time to counter-act any previous deficiencies. There is a good range of gluten-free foods available as well as recipe books.

Improvements begin within days of starting a gluten-free diet. The small intestine is usually completely healed in 3 to 6 months; individuals start to regain lost weight and are able to lead a normal and healthy life.

Patients are advised to see a dietician for guidance on foods that are gluten-free and to monitor their progress carefully. Foods that contain wheat, barley and rye should be avoided. There is growing evidence that most adults with moderate coeliac disease can eat oats.

Since coeliac disease runs in families, relatives can have a blood test to check for antibodies.

As coeliac disease can lead to long-term complications, patients should regularly see their GP and visit the out-patient clinic every 6-12 months. A biopsy 4-6 months after beginning the gluten-free diet should show improvement in the small intestine. Regular tests for osteoporosis may be recommended for a minority of patients.

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To prevent symptoms of coeliac disease from occurring it is necessary to completely eliminate gluten from the diet. NHSDEC07