Coeliac disease

AGE Usually occurs in the first year of life but can occur at any age	GENDER More common in females
LIFESTYLE Not a significant factor	GENETICS Sometimes runs in families

Coeliac disease is the malabsorption due to the intestine being damaged by a reaction to gluten, a protein found in many foods.

Coeliac disease, commonly called sprue, is a condition caused by the protein gluten, which is found in wheat, rye, barley, and to some extent in oats. In people with the disease, the lining of the small intestine is damaged so that food cannot be properly absorbed (see Malabsorption). The exact mechanism of damage is uncertain, but it seems to be due to an abnormal immune response in which antibodies against gluten are produced. The resulting malabsorption leads to a deficiency of many nutrients, including vitamins and minerals that are vital for good health. Coeliac disease can run in families, which suggests that genetic factors are involved.

In the UK, coeliac disease affects about 1 in 1,000 people. The condition is very rare in Africa and Asia.

What are the symptoms of coeliac disease?

In babies, the symptoms of coeliac disease first appear soon after cereals are introduced into the diet, usually at 3 or 4 months. In adults, the symptoms usually develop gradually and include:

Bulky, loose, foul-smelling faeces that looks greasy.
Abdominal bloating and flatulence.
Weight loss.
Weakness and tiredness.
Sometimes, a persistent, itchy rash on the knees, buttocks, elbows, and shoulders (see Blistering diseases).

In babies and children, the following symptoms may also occur:

Diarrhoea.
Failure to grow or gain weight.
Muscle wasting, especially around the buttocks.

Vitamin and mineral deficiencies may lead to disorders such as iron-deficiency anaemia and osteomalacia (see Osteomalacia and rickets), which is due to a lack of vitamin D and calcium. Untreated, coeliac disease may increase the risk of cancers, particularly cancer of the small intestine.

How is coeliac disease diagnosed?

Your doctor may suspect coeliac disease from your symptoms, especially if you have the characteristic rash described here. A blood test for antibodies may help to confirm the diagnosis. The doctor may suspect the condition in a baby if symptoms developed soon after solid foods were introduced.

Diagnosis involves removing a small sample of tissue from the lining of the small intestine. This procedure is performed using an endoscope inserted through the mouth (see Upper digestive tract endoscopy). When the tissue is examined under a microscope, the intestinal lining appears flattened. You may also have blood tests to look for evidence of anaemia.

What is the treatment?

Coeliac disease is treated by removing gluten from your diet. The recommended diet can be complicated, and it is advisable to see a dietitian for guidance. You should avoid foods that contain wheat, rye, and barley. Of the cereals, only rice, corn, and possibly oats are suitable. It is not advisable to eat mustard, pasta, salad dressing, and some margarines because they contain wheat or wheat extracts, and you should avoid drinking beer. Initially, you may also need to take supplements of vitamins and minerals.

Removing gluten from the diet usually produces a substantial and rapid improvement, and eventually the symptoms may totally disappear. However, coeliac disease is a lifelong disorder and may reappear if gluten is reintroduced. Since coeliac disease sometimes runs in families, relatives of an affected person may be screened for the disorder by having a blood test to check for antibodies produced in the disease.

Posted 09.09.2010

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