Coeliac Disease
What is Coeliac Disease?
Coeliac Disease (CD) is an autoimmune disease of the small intestine caused by an intolerance to gluten in genetically predisposed individuals. Gluten is a general name for a group of proteins present in wheat, rye, barley, and other grains derived from them. It is an autoimmune disease because the immune system redundantly attacks and damages healthy tissues. When exposed to gluten, the immune system will initiate an immune response and attacks the small intestine. This damages the surface of the small intestine which is responsible for the absorption of nutrients from food. As a result of this damage, the body can no longer absorb adequate amounts of nutrients and leads to a variety of symptoms.
Coeliac disease can be classified into classical Coeliac disease, non-classical Coeliac disease, silent Coeliac disease, and refractory Coeliac disease:
- Classical form: this form is characterized by malabsorption and abnormalities of the small intestine.
- Non-classical form: this form primarily presents with symptoms not associated with intestinal malfunction. Symptoms may include loss of bone density (osteoporosis), anemia, infertility, etc.
- Silent form: Silent CD occurs when the individual does not exhibit symptoms but experiences intestinal damage.
- Refractory form: In some individuals who initially respond to treatment, symptoms may recur after some time. This is known as the refractory form.
Synonyms
- Coeliac disease
- Coeliac sprue
- gluten-sensitive enteropathy
- non-tropical sprue
Coeliac Disease (CD) is an autoimmune disease of the small intestine caused by an intolerance to gluten in genetically predisposed individuals. Gluten is a general name for a group of proteins present in wheat, rye, barley, and other grains derived from them. It is an autoimmune disease because the immune system redundantly attacks and damages healthy tissues. When exposed to gluten, the immune system will initiate an immune response and attacks the small intestine. This damages the surface of the small intestine which is responsible for the absorption of nutrients from food. As a result of this damage, the body can no longer absorb adequate amounts of nutrients and leads to a variety of symptoms.
Coeliac disease can be classified into classical Coeliac disease, non-classical Coeliac disease, silent Coeliac disease, and refractory Coeliac disease:
- Classical form: this form is characterized by malabsorption and abnormalities of the small intestine.
- Non-classical form: this form primarily presents with symptoms not associated with intestinal malfunction. Symptoms may include loss of bone density (osteoporosis), anemia, infertility, etc.
- Silent form: Silent CD occurs when the individual does not exhibit symptoms but experiences intestinal damage.
- Refractory form: In some individuals who initially respond to treatment, symptoms may recur after some time. This is known as the refractory form.
The prevalence of Coeliac disease is approximately one in a hundred individuals. The prevalence has been increasing over the past few decades. Individuals with other autoimmune disorders or first-degree relatives with Coeliac disease are more likely to be affected.
| Name | Abbreviation |
|---|---|
| Coeliac disease | Coeliac Disease |
| Coeliac sprue | Coeliac Disease |
| gluten-sensitive enteropathy | Coeliac Disease |
| non-tropical sprue | Coeliac Disease |
Coeliac disease is caused by a combination of genetic, dietary, and environmental factors. The genes most associated with Coeliac disease are Human Leukocyte Antigen (HLA) DQ2 and HLA-DQ8. These are both involved in proteins involved in the recognition of foreign particles by the immune system. All individuals affected by coeliac disease have a mutation in one of these genes. Genetic predisposition is necessary for the development of Coeliac disease but it is not sufficient.
Another important factor in developing Coeliac disease is exposure to gluten. A molecule derived from gluten, gliadin, can damage the surface of the small intestine and make it more permeable. As a result, gliadin can the surface barrier on small intestine which exposes them to immune cells. In genetically predisposed individuals, the immune system will react to gliadin, leading to inflammation and further immune attack. These immune processes damage microscopic structures on the surface of the small intestine called villi. Villi are finger-like projections that increase the surface area of the small intestine and are responsible for the absorption of nutrients. Damage to these villi will reduce absorption and lead to symptoms associated with Coeliac disease. Milk-feeding patterns and duration also seem to be involved in triggering Coeliac disease. Consumption of gluten-containing foods before three months of age increases the likelihood of developing Coeliac disease. Finally, certain bacterial infections have also been noted as a triggering factor.
Some individuals are affected by silent or asymptomatic Coeliac disease. These individuals have damaged intestinal villi but do not present any symptoms. The individuals affected by classical types exhibit digestive symptoms such as diarrhea, nausea, vomiting, bloating, abdominal pain, and constipation. Digestive symptoms are more common in children than in adults. In children, failure to thrive or slow physical growth is also common. In adults, sudden and unexplained weight loss is observed.
Many adults are affected by the atypical type and experience symptoms unrelated to the gastrointestinal system. These include anemia due to iron deficiency, loss of bone density or osteoporosis, mouth ulcers, chronic headaches, delayed menarche, and dental enamel problems. Coeliac disease can also occur with dermatitis herpetiformis. This is a blistering skin disease that occurs on the elbows, knees, torso, scalp, and buttocks.
In addition, malabsorption in children may also result in delayed puberty, irritability, and neurological symptoms such as attention-deficit and hyperactivity disorder (ADHD).
| Name | Description |
|---|---|
| Chronic diarrhoea | Chronic diarrhoea |
| Fatigue | Fatigue |
| Weight Loss | Weight Loss |
| Decreased absorption of nutrients | Decreased absorption of nutrients |
The first step in the diagnosis of Coeliac disease is blood tests. Antibodies are proteins released by the immune system in response to specific molecules that are identified as foreign. In Coeliac disease, certain antibodies are elevated in the blood. If these blood antibodies appear to be elevated, the next step and the most certain diagnostic test for Coeliac disease is biopsy. Genetic testing can also be performed in uncertain cases to confirm the diagnosis. The presence of HLA-DC2 or HLA-DQ8 can strengthen the diagnosis.
Blood testing is the first step in the diagnosis of Coeliac disease. In this test, a blood sample is drawn and tested for the presence of specific antibodies using techniques that identify specific proteins. It is important to do this test prior to committing to a gluten-free diet because such a diet can lead to a reduction in antibody levels.
The diagnostic standard for Coeliac disease is a biopsy. A biopsy is a procedure in which a sample of the affected tissue is removed and examined microscopically. In Coeliac disease, endoscopy is used to obtain a small sample from the small intestine. Endoscopy is a test in which a long tube with a small camera at the tip is inserted into the mouth and passed through the throat. The removed sample can be examined for the presence of villi damage and other characteristics of Coeliac disease.
If dermatitis herpetiformis is suspected, then a skin sample will be obtained and examined.
Currently, the only treatment that exists for Coeliac disease is a lifelong, gluten-free diet. Affected individuals must strictly avoid all dietary sources of gluten such as wheat, rye, and barley. This treatment is however not effective in individuals with refractory Coeliac disease. In such cases, immunosuppressive medications such as corticosteroids may be required to reduce the activity of the immune system and inflammation.
If left untreated, Coeliac disease can lead to the development of many other conditions such as intestinal cancer and other autoimmune disorders such as type I diabetes. Compliance with a gluten-free diet is typically effective in symptom reduction and leads to the recovery of damaged intestinal surface within a few years. Prognosis also depends on the type of Coeliac disease. The refractory type is more difficult to manage is it does not respond to a gluten-free diet.
Complying to a gluten-free diet can be challenging and a dietitian can help affected individuals plan a gluten-free diet that is healthy and satisfies their nutritional needs. Additionally, gluten contamination can occur in food sources that do not typically contain gluten. Therefore, being mindful about this contamination can be helpful.
Canadian Celiac Association. Coeliac Disease. 2016. Available from https://www.Coeliac.ca/gluten-related-disorders/Coeliac-disease/
Coeliac Disease Foundation. About Coeliac Disease. Available from https://Coeliac.org/about-Coeliac-disease/what-is-Coeliac-disease/
Parzanese I, Qehajaj D, Patrinicola F, et al. Coeliac disease: From pathophysiology to treatment. World Journal of Gastrointestinal Pathophysiology. 2017; 8(2):27–38. doi:10.4291/wjgp.v8.i2.27
Gujral N, Freeman H, Thomson A. Coeliac disease: prevalence, diagnosis, pathogenesis and treatment. World Journal of Gastroenterology. 2012;18(42):6036–6059. doi:10.3748/wjg.v18.i42.6036
Posner E, Haseeb M. Coeliac Disease. [Updated 2018 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441900/
Walker M, Ludvigsson J, Sanders D. Coeliac disease: review of diagnosis and management. Medical Journal of Australia. 2017;207(4): 173-178.
Tye-Din J, Galipeau H, Agardh D. Coeliac Disease: A Review of Current Concepts in Pathogenesis, Prevention, and Novel Therapies. Frontiers in Pediatrics. 2018;6:350. Published 2018 Nov 21. doi:10.3389/fped.2018.00350
Amil Dias J. Coeliac Disease: What Do We Know in 2017?. Portuguese Journal of Gastroenterology. 2017;24(6):275–278. doi:10.1159/000479881
Last updated 30 Jul 2009, 01:24 AM
30 Jul 2009, 01:24 AM
I was just diagnosed with celiacs a few days ago. What kind of doctor takes care of this disease. Does anyone see a gastroenterologist. If so, do you see them yearly. Also, does anyone subscribe to the magazine Living Without which deals with celiac and other food allergies. Is it a good magazine. Beth
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ongoing treatment for celiac
Created by beth | Last updated 30 Jul 2009, 01:24 AM
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