Figure 102.1 What causes coeliac disease? Figure 102.2 Common symptoms Figure 102.3 The Crossed Grain symbol Figure 102.4 Medical treatments Figure 102.5 Normal villi and damaged villi in coeliac disease
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Coeliac disease
Coeliac disease is an immune-mediated systemic disorder in which the immune system in a person’s gut reacts to a protein gliadin that makes up gluten. The antibodies produced against gliadin cause inflammation to the surface of the gut. The damage and inflammation to the gut lining flattens villi that are present in the small bowel.
The villi work by increasing the surface area of the gut and aid to digest food more effectively. However, in the case of coeliac disease, the flattened villi are unable to work this way, resulting in the inability to digest nutrients from foods, leading to symptoms such as diarrhoea and weight loss.
What causes coeliac disease?
It is not fully understood why people develop coeliac disease or why some people’s symptoms are more severe than others. However, there are a number of contributing factors that are known to increase the risk of developing coeliac disease, such as family history, environmental factors and other pre-existing health conditions.
Who should be tested for coeliac disease?
Children with coeliac disease present with a variety of non-specific signs and symptoms. Therefore, it is important to identify and diagnose those children who have a less clear clinical picture in order to reduce and prevent negative health consequences caused by the disease:
- Symptomatic children and adolescents with otherwise unexplained symptoms and signs that suggest coeliac disease such as chronic or intermittent diarrhoea.
- Asymptomatic children and adolescents who have an increased risk of coeliac disease due to pre-existing medical conditions such as type 1 diabetes mellitus, Down’s syndrome, autoimmune thyroid disease and those who have a first-degree relative with coeliac disease.
How is coeliac disease diagnosed?
Screening for coeliac disease involves a two-stage diagnostic process. Blood tests to identify coeliac disease specific antibodies should be the first diagnostic tool used. The initial tests are IgA class anti-TGN, IgG anti-TGN and IgG anti-DGP. However, in some cases it is possible to have coeliac disease despite negative blood results. It is therefore important to confirm diagnosis with a histology biopsy. Biopsies are obtained during gastroscopy and should be taken from the duodenal bulb and the second and third part of the duodenum. NB. Coeliac disease will only be identified from intestinal biopsy if the person being tested is eating gluten regularly.
How is coeliac disease treated?
Once coeliac disease has been diagnosed, the treatment is a strict gluten-free diet. Children and adolescents should be referred to a dietitian for support and advice in adjusting to the new gluten-free diet and ensure that a balanced diet containing nutrients is maintained. By sticking to this strict diet symptoms should improve considerably within weeks.
Untreated or undiagnosed coeliac disease can cause long-term complications:
- Osteoprosis
- Malnutriton
- Lactose intolerance
- Cancer.
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