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What is coeliac disease?
Coeliac disease is an autoimmune disease where eating gluten causes the body to produce antibodies that attack the bodies own tissues.
Gluten is a protein occurring in wheat, barley, rye, spelt and in some cases oats. It acts like a glue binding flours together and providing elasticity in bread. In some people, consumption of even small amounts of gluten causes an immune reaction leading to inflammation and damage to the lining of the small intestine, causing a diverse spectrum of symptoms. In healthy people, the walls of the intestine are covered with fingerlike projections called villi, which increase the surface and contact area for absorption of nutrients. Gluten can cause the villi to be flattened and the intestinal membrane to be damaged. This means the intestinal wall is no longer able to absorb nutrients properly, causing malabsorption syndrome and various nutritional deficits.
Gluten intolerance is one of the most common disorders worldwide. In European countries the incidence of coeliac disease is thought to be 1 in 100 but only 10-15% of people are diagnosed.
Coeliac disease does have a genetic component. If you have a relative with coeliac disease you should be aware of the symptoms and contact your GP if you think you need testing. The prevalence of coeliac disease is 10 times greater in first order relatives of patients with coeliac disease than in the general population.
What are the symptoms of coeliac disease?
Coeliac disease can produce a variety of symptoms and can even be asymptomatic. It is often undiagnosed or misdiagnosed due to the range of symptoms patients can present with.
Common symptoms include: diarrhoea, bloating, weight loss, fatigue, headaches, bone pain, wind and abdominal pain. In children growth problems, rickets, iron-resistant anaemia, and personality problems can be symptoms. Infants may show vomiting, diarrhoea and abdominal pain.
Coeliac disease should be considered in people with iron or folate anaemia, unexplained vitamin and mineral deficiencies, chronic fatigue, persistent mouth ulcers, in those with osteoporosis, type 1 diabetes, no menstrual cycle, fertility problems, autoimmune thyroid disease, unexplained neurological disorders, and a family history of coeliac disease.
What should be done when coeliac disease is suspected?
If you have a suspicion of coeliac disease it is important to continue eating gluten until you have been tested. The first step is to visit your GP, they will arrange a blood test that test your antibodies. In people with coeliac disease Endomysial antibodies (EMA) and tissue Transglutaminase antibodies (tTGA) are produced when gluten is eaten. It is possible to have a false negative test therefore final diagnosis requires intestinal biopsy, where a small tissue fragment is collected and the villi are looked at to see if they are flattened or damaged.