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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

How common is coeliac disease?

  • 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
  • Coeliac disease is common in Western countries, but less common in South Africa.
What causes coeliac disease?
  • Some people have a specific gene that makes it more likely for them to develop coeliac disease.
  • When they eat gluten, they develop abnormal antibodies to proteins in their own bodies,called auto-antibodies.
  • Antibodies are proteins in the immune system that usually attack viruses and bacteria toprotect the body.
  • In coeliac disease these antibodies attack the body itself and cause damage to the lining of thegut and other organs.
  • Coeliac disease is different from a wheat allergy where IgE mediated antibodies causesymptoms.
What are the symptoms of coeliac disease?

The symptoms of coeliac disease can vary from mild to severe.
Common symptoms include:
Diarrhoea | Pale, smelly stools | Constipation | Poor appetite | Bloating, gas and abdominal pain| Weight loss | Nausea and vomiting | Delayed onset of puberty | Not menstruating | Tirednessor weakness | Mouth ulcers | Itchy blistering skin rash
Less commonly:
Infertility | Thinning of the bones | Poor growth | Low blood count due to a lackof iron | Tooth abnormalities
These symptoms may develop at about 6-24 months with the introduction of gluten-containingsolids in the diet but may also develop later in childhood or adulthood.

How is coeliac disease diagnosed?

When coeliac disease is suspected, the first step is to do a blood test. Before doing the test the
person should be eating normal amounts of gluten for at least 6 weeks, because avoiding gluten
can cause false negative tests.
They are:

  • Tissue transglutaminase 2 IgA and IgG (anti-TG2)
  • Endomysial IgA (EMA)

If the levels of antibodies are high, celiac disease is very likely.

The diagnosis may be confirmed by looking at a sample of a small piece of the lining of small
bowel under a microscope. This involves swallowing an instrument with a camera on the tip (a
“scope”). 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.

Who should be tested for coeliac disease?
  • People with symptoms that might be due to celiac diseases, like unexplained diarrhea, bloating, abdominal pain, poor weight gain, iron deficiency anemia, slow growth or easy bone fractures.
  • Some people (family members of a patient with coeliac disease or people with auto-immune thyroid disease, insulin-dependent diabetes, or Downs syndrome) have a higher chance of having coeliac disease and may need to be tested even if they don’t have any symptoms.
How is coeliac disease treated?
  • 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 qualified dietician can help you to avoid gluten-containing foods while still eating enough protein, energy, minerals, and vitamins.
Can coeliac disease be prevented?

Studies have shown that introducing gluten at the age of 4-6 months while continuing breastfeeding may reduce the risk of developing coeliac disease.

Label ingredients that indicate the presence of wheat proteins:

high- protein



Download our “Coeliac disease” leaflet for free