Coeliac Disease

Last updated: 06 November 2007

What is Coeliac Disease?

Coeliac disease is a genetically based permanent intolerance to dietary gluten. Gluten is a protein found in Wheat, barley, oats, rye. Untreated, it can result in malabsorption and a predisposition to gastrointestional malignancy, particularly carcinoma of the oropharynx and oesophagus, and small bowel lymphoma. The disease may present in either children or adults.

What is the cause?

In coeliac disease the cells of the small bowel (intestine) are damaged (villous atrophy). This causes a flattening of the tiny, finger like projections, called villi, which line the inside of the bowel. The function of the cells on normal villi is to break down and absorb nutrients in food. In coeliac disease, these cells become flat and inflamed and the surface area, which enables the absorption of nutrients and minerals from food, is seriously depleted.

Incidence

The incidence of coeliac disease in a number of European countries is estimated at least 1 in 100, with slightly more women than men being affected. Growing awareness of coeliac disease, better diagnoses, and improved screening, point to the possibility of similar figures in Australia.

Symptoms

The presentation of coeliac disease is changing, and typical malabsorption is one of many presentations. Patients are likely to present with non-specific symptoms or with iron and / or folate deficiency or unexplained early onset of osteoporosis.
The following symptoms may occur singularly or in combination:
    • Anaemia - iron and/or folic acid deficiencies
    • Fatigue, weakness and lethargy
    • Deficiency of vitamins A, D, E, K & B12
    • Diarrhoea, sometimes constipation (often both)
    • Flatulence, bloating, abdominal pain
    • Nausea and vomiting
    • Mouth ulcers
    • Weight loss
    • Easy bruising of the skin
    • Bone and joint pain
    • Miscarriages and infertility
    • Low blood calcium levels with muscle spasms
    • Skin rashes such as dermatitis herpetiformis

Additional Symptoms in Children
    • Dental abnormalities
    • Retarded growth
    • Delayed puberty
    • Irritability

Diagnosis

Diagnosis relies upon proving that the small bowel lining shows the typical damage (villous atrophy). This is done by endoscopy, preferable with multiple biopsies of the distal duodenum and proximal jejunum. A specific
panel of blood tests that measure antibodies to gluten is available as a screening aid in the diagnosis of coeliac disease. The two most commonly used investigations test for antigliadin antibody (AGA) and endomysial antibody (EMA). These are IgA antibodies. Testing for IgG antibodies is of little value since the sensitivity and specificity are only approximately 50%. The tests for antibody to tTG is now the most common test for screening.

A gluten free diet should never be started before an endoscopy or blood tests, as it will interfere with establishing the correct diagnosis and may delay the diagnosis of another condition with similar symptoms.

How is the condition treated?

The only treatment for coeliac disease is a strict, lifelong gluten free diet. By specifically removing the cause of the disease, this treatment allows all abnormalities, including that of the bowel lining, to recover and will reduce the risk of developing other associated diseases.

Further Information

For more information on coeliac disease, dermatitis herpetiformis and the gluten free diet, please contact :

The Coeliac Society of NSW Inc, P O Box 721, Wahroonga NSW 2076
Phone: (02) 9487 5088 Fax: (02) 9487 5177