Coeliac disease is an autoimmune condition in which eating gluten causes the immune system to attack the lining of the small intestine. It is also spelt celiac disease in some countries, but coeliac disease is the usual British spelling.
Gluten is a protein found in wheat, barley and rye. In coeliac disease, gluten exposure damages the small intestine and can reduce absorption of nutrients from food.
Symptoms
Coeliac disease can cause gut symptoms such as diarrhoea, abdominal pain, bloating, wind, constipation, nausea and weight loss. Some people have few gut symptoms but develop tiredness, anaemia, mouth ulcers, headaches, fertility problems, nerve symptoms, poor growth in children or low bone density.
Symptoms vary widely. A person can have significant intestinal damage even when symptoms are mild.
Causes
Coeliac disease develops in people with genetic susceptibility. The immune reaction is triggered by gluten. The condition is more common in people with a family history of coeliac disease and in people with some other autoimmune conditions, including type 1 diabetes and autoimmune thyroid disease.
It is different from a wheat allergy and from non-coeliac gluten sensitivity.
Diagnosis
Diagnosis usually starts with blood tests for coeliac antibodies. NICE guidance covers recognition, assessment and management in children, young people and adults. If blood tests suggest coeliac disease, referral and further assessment may include an intestinal biopsy, depending on age and clinical context.
Testing is most accurate while the person is still eating gluten. Starting a gluten-free diet before testing can make results harder to interpret.
Treatment
The main treatment is a strict gluten-free diet. That means avoiding wheat, barley and rye, including hidden sources in processed food, sauces, some drinks and cross-contamination.
A gluten-free diet allows the small intestine to heal in many people. NHS inform notes that symptoms may improve within weeks, but full healing of the digestive system can take much longer.
Gluten-Free Living
Living gluten-free involves more than replacing bread and pasta. People with coeliac disease often need to check labels, shared fryers, kitchen surfaces, oats, sauces, medicines and supplements. Oats are naturally gluten-free, but some are contaminated with wheat, barley or rye unless produced and labelled as gluten-free.
Dietetic support can help with fibre, iron, calcium, vitamin D, folate and other nutrients, especially soon after diagnosis.
Dermatitis Herpetiformis
Dermatitis herpetiformis is a skin condition linked to coeliac disease. It causes an itchy, blistering rash and is associated with the same gluten-driven immune process. Treatment usually involves a gluten-free diet and, in some cases, medicine prescribed by a clinician.
Complications
Untreated coeliac disease can lead to anaemia, osteoporosis, poor growth in children, fertility problems, pregnancy complications, vitamin and mineral deficiency and, rarely, certain cancers such as intestinal lymphoma.
Good dietary control and follow-up reduce many of these risks.
Follow-Up
Follow-up may include symptom review, diet review, repeat blood tests, checking nutrient levels and assessment of bone health where needed. NICE recommends annual review for people with coeliac disease.
See Also
References
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