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Coeliac Disease

  
 
Last Update:
24/11/2004
Please Note: This information is intended for educational purposes only. It is not intended to be medical advice. If you think you require medical advice, please consult a doctor.

Introduction
Coeliac disease (also called celiac disease, nontropical sprue, celiac sprue, gluten intolerant enteropathy, or gluten sensitive enteropathy) is a condition in which there is a chronic reaction to certain proteins called glutens, found in some cereal grains. This reaction causes destruction of the villi in the small intestine, with resulting malabsorption of nutrients.

Coeliac disease runs in families. About 10% of the close relatives (parents, children, and siblings) of coeliacs may develop coeliac disease. The disease affects both sexes, and it can begin at any age, from infancy (as soon as cereal grains are introduced) to later life (even though the person has eaten wheat all their life). The onset of the disease seems to require two components: a genetic predisposition, and some kind of trigger. The trigger may be environmental (as in overexposure to wheat), situational (perhaps severe emotional stress), physical (such as a pregnancy, an operation), or pathological (a viral infection).

Once thought to be a childhood disease that would be outgrown, recent evidence indicates that it is not uncommon for the symptoms of coeliac disease to disappear during late childhood or adolescence, giving the appearance of a cure. Unfortunately, damage still occurs during these years of apparent health, and later in life these coeliacs may find they have suffered considerable damage to the small intestine, and have for years deprived themselves of important nutrients.



Effects
Untreated coeliac disease can be life threatening. Coeliacs are more likely to be afflicted with problems relating to malabsorption, including osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal haemorrhaging, organ disorders, and gynaecological disorders. Fertility may also be affected. Some researchers are convinced that gluten intolerance, whether or not it results in full-blown coeliac disease, can impact mental functioning in some individuals and cause or aggravate autism, Asperger's syndrome, attention deficit disorder (ADD), and schizophrenia. Some or all of the damage may be healed after time on a gluten-free diet. Coeliacs who do not maintain a gluten-free diet also stand a much greater chance of getting certain types of cancer, especially intestinal lymphoma.

Untreated coeliac disease can cause temporary lactose intolerance. Lactose is a sugar found in dairy products. To be digested it must be broken down by an enzyme called lactase. Lactase is produced on the tips of the villi in the small intestine. Since gluten damages the villi, it is common for untreated coeliacs to have problems with milk and milk products. (Yoghurt and cheese are less of a problem since the cultures in them break down the lactose). A gluten-free diet will usually eliminate lactose intolerance. However, some people (both coeliacs and non-coeliacs) are lactose intolerant even with a healthy small intestine; in that case a gluten-free diet will not eliminate lactose intolerance.

Coeliacs often suffer from other food intolerances. These may respond to a gluten free diet--or they may not. Soy, corn and MSG are examples of food products that some coeliacs may not tolerate.


Symptoms

There is no typical coeliac. Individuals range from having no symptoms, to extreme cases where patients present to their doctor with gas, bloating, diarrhoea, and weight loss due to malabsorption.

In between these two extremes lie a wide variety of symptoms that include:

  • Diarrhoea
  • Constipation
  • Steatorrhea (fatty stools that float rather than sink)
  • Abdominal pain
  • Excessive gas
  • Any problem associated with vitamin deficiencies
  • Iron deficiency (anaemia)
  • Chronic fatigue
  • Weakness
  • Weight gain
  • Weight loss
  • Bone pain
  • Easily fractured bones
  • Abnormal or impaired skin sensation, including burning, prickling, itching or tingling
  • Headaches
  • Peripheral Neuropathy (tingling in fingers and toes)

Individuals have reported such varied symptoms as:

  • White flecks on the fingernails
  • Fuzzy-mindedness after gluten ingestion
  • Burning sensations in the throat

In children, the symptoms may include:

  • Failure to thrive
  • Paleness
  • Querulousness, irritability
  • Inability to concentrate
  • Wasted buttocks
  • Potbelly with or without painful bloating
  • Pale, smelly, bulky stools
  • Frequent, foamy diarrhoea

 

Diagnosis

The traditional approach to diagnosing coeliac disease is a three-step process. The tests look for damage caused by eating gluten, so if a person has been successfully following a gluten free diet, the tests will be negative even if they have coeliac disease.

  1. Perform a biopsy of the lining of the small intestine. This is a simple procedure, although small children are usually sedated first, which adds to the complexity of the biopsy. If the villi are damaged (flattened or atrophied mucosa), go to step 2.
  2. Place the patient on a gluten free diet for six months or longer and then perform another biopsy. If the villi are healed, go to step 3.
  3. Put gluten back in the diet for six months or longer, and then perform a third biopsy. If the villi are again damaged, then the diagnosis is complete. At this point, the patient goes on a gluten-free diet for life.


Treatment
There are no drugs to cure coeliac disease. In fact, there is no cure. Coeliacs can lead a normal, healthy life by following a diet that contains no gluten. This means avoiding all products derived from wheat, rye, barley and oats.

Extra vitamins may be taken, if necessary, but the only way for a coeliac to avoid damage to their intestinal villi and the associated symptoms, is by maintaining a gluten free diet.

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