Coeliac disease2017-06-21T22:50:43+00:00

Coeliac disease

What is coeliac disease?

  • Coeliac disease is a condition where the immune system responds abnormally to a food protein called gluten found in food containing wheat, rye or barley
  • This causes damage to the gut lining of the small intestine, poor absorption of food and growth problems
  • Symptoms include diarrhoea, bloating and stomach pain. It can also cause sore joints, headaches and ‘flu-like symptoms
  • Avoidance of gluten-containing food causes the lining of the intestine to heal and symptoms to improve
  • Other names used for coeliac disease are gluten sensitive enteropathy, coeliac sprue and nontropical sprue
  • Coeliac disease occurs in 1/100 people in the United Kingdom and is one of the most common life-long conditions in Western countries
  • The incidence in South Africa is unknown, but it is probably under-diagnosed
  • Coeliac disease is more common in people with insulin-dependent diabetes, Down’s syndrome, selective IgA deficiency, auto-immune disorders or a family history of coeliac disease
  • When exposed to the gluten protein in wheat, barley and rye, genetically susceptible people develop abnormal antibodies to proteins in their own bodies, called auto-antibodies
  • Antibodies are proteins in the immune system that usually attacks viruses and bacteria to protect the body
  • In coeliac disease these antibodies attack the body itself and cause damage to the lining of the gut and other organs. This results in the symptoms of coeliac disease
  • Coeliac disease is different from a wheat allergy where IgE mediated antibodies cause symptoms

The symptoms of coeliac disease can vary from mild to severe and from person to person.

Common symptoms include:

  • Diarrhoea
  • Pale, smelly stools
  • Constipation
  • Poor appetite
  • Bloating, excessive gas production and abdominal pain
  • Weight loss or difficulty in gaining weight
  • Nausea and vomiting
  • Delayed onset of puberty
  • Not menstruating
  • Tiredness or weakness
  • Mouth ulcers
  • Itchy blister-like skin rash called dermatitis herpetiformis

Less common symptoms:

  • Infertility
  • Disorders of the nervous system
  • Thinning of the bones
  • Poor growth
  • Iron deficiency anaemia (low blood count due to a lack of iron)
  • Teeth abnormalities

These symptoms may develop in infancy at about 6-24 months with the introduction of gluten-containing solids in the diet, but may also develop later. Children present with the common gastrointestinal symptoms, where adults present with the less common symptoms.

When coeliac disease is suspected, the first step would be a blood test.
They are:

  • Tissue transglutaminase 2 IgA and IgG (anti-TG2)
  • Endomysial IgA (EMA)
  • It is important to test the total IgA level as well when doing these tests, as a general IgA deficiency can give false normal results
  • Before doing the test the person should be eating normal amounts of gluten, as gluten avoidance can cause false negative tests
  • If the levels of antibodies are high, celiac disease is very likely

 

The diagnosis may be confirmed by a biopsy of the small bowel taken during a gastroscopy. This involves swallowing an instrument with a camera on the tip. A small piece of intestinal lining (the biopsy) will then be examined under a microscope. In Coeliac disease we see flattening of the finger-like structures of the intestinal lining that absorb nutrients, and a build-up of inflammatory cells in the lining.
Endoscopy pic, normal pic, coeliac pic

  • Two groups of patients should be tested for coeliac disease
  • Firstly those with suggestive symptoms of celiac disease, either common symptoms like diarrhoea, bloating, abdominal pain and poor weight gain, or the less common symptoms like iron deficiency anaemia, slow growth or easy bone fractures due to thinning of the bones
  • The second group is those without symptoms but with an increased risk of developing coeliac disease, like family members of a patient with coeliac disease, auto-immune thyroiditis, insulin dependent diabetes or Downs syndrome
  • The most important treatment for coeliac disease is total avoidance of all foods containing gluten
  • Although coeliac disease cannot be cured, the symptoms mostly resolve on a gluten free diet
  • A skilled dietician is vital to provide guidance with respect to safe and unsafe foods, reading food labels and where to find gluten-free products
  • Newer treatment strategies are investigated but not available yet
Studies have shown that introducing gluten at the age of 4-6 months while continuing breastfeeding may reduce the risk of developing coeliac disease.

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