Introduction
- Coeliac disease is a chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye.
- It causes inflammation and damage to the small intestine, leading to malabsorption of nutrients.
- The only effective treatment is a lifelong gluten-free diet. Early diagnosis and adherence to treatment are critical to preventing complications.
Causes of Coeliac Disease
- Genetic Factors
- Strongly associated with the HLA-DQ2 and HLA-DQ8 genes.
- A family history of coeliac disease increases risk.
- Immune Response
- Ingestion of gluten triggers an autoimmune reaction, damaging the intestinal lining (villi).
- Environmental Triggers
- Early exposure to gluten or infections may contribute to disease onset.
- Other Autoimmune Disorders
- Often associated with type 1 diabetes, thyroid disease, or autoimmune hepatitis.
Symptoms of Coeliac Disease
- Gastrointestinal Symptoms
- Diarrhoea or constipation.
- Abdominal pain and bloating.
- Nausea or vomiting.
- Malabsorption Symptoms
- Unintended weight loss.
- Fatigue or weakness.
- Iron-deficiency anaemia.
- Non-Gastrointestinal Symptoms
- Dermatitis herpetiformis (itchy skin rash).
- Joint pain or arthritis.
- Neurological issues like numbness, tingling, or migraines.
- Symptoms in Children
- Delayed growth and puberty.
- Failure to thrive.
- Behavioral issues or irritability.
Complications of Untreated Coeliac Disease
- Malnutrition: Deficiencies in iron, calcium, vitamin D, and B12.
- Osteoporosis: Due to calcium and vitamin D malabsorption.
- Infertility and Miscarriage: In women of reproductive age.
- Neurological Disorders: Ataxia or peripheral neuropathy.
- Increased Cancer Risk: Small bowel lymphoma and other gastrointestinal cancers.
- Other Autoimmune Disorders: Higher prevalence of type 1 diabetes, thyroid disease.
Diagnosis of Coeliac Disease
- Blood Tests
- Anti-Tissue Transglutaminase Antibodies (tTG-IgA): Most common screening test.
- Deamidated Gliadin Peptide Antibodies (DGP): Alternative test.
- Total IgA levels to rule out IgA deficiency.
- Endoscopy with Biopsy
- Gold standard for diagnosis; involves taking samples of the small intestine to check for villous atrophy.
- Genetic Testing
- HLA-DQ2 and HLA-DQ8 testing may rule out coeliac disease if absent.
- Gluten Challenge
- Reintroducing gluten before testing if a gluten-free diet has already been started.
Management and Treatment of Coeliac Disease
1. Gluten-Free Diet (Primary Treatment)
Foods to Avoid
- Wheat, barley, rye, triticale, and oats (unless certified gluten-free).
Safe Foods
- Fresh fruits, vegetables, meat, fish, poultry, eggs, rice, corn, potatoes, quinoa, and certified gluten-free products.
Hidden Sources of Gluten
- Processed foods, sauces, soups, dressings, and medications.
Cross-Contamination Prevention
- Use separate cooking utensils, toasters, and storage for gluten-free and gluten-containing foods.
2. Nutritional Support
- Supplements for Deficiencies: Iron, calcium, vitamin D, and B12 as needed.
- Lactose-Free Diet: Temporary in severe cases to aid digestion.
3. Medications and Therapies
- Dermatitis Herpetiformis Treatment: Dapsone for skin symptoms, alongside a gluten-free diet.
- Corticosteroids: For refractory coeliac disease with severe intestinal inflammation.
4. Monitoring and Follow-Up
- Regular follow-ups with a gastroenterologist and dietitian.
- Repeat blood tests to monitor antibody levels.
- Bone density scans (DEXA) for osteoporosis risk assessment.
- Address persistent symptoms or complications with additional evaluations (e.g., refractory coeliac disease or lymphoma).
5. Psychological Support
- Address emotional challenges, such as dietary restrictions and social isolation.
- Support groups or counselling for coping strategies.
Monitoring Parameters
- Antibody Levels: Monitor tTG-IgA levels to assess dietary adherence.
- Nutritional Status: Regular checks for deficiencies in iron, calcium, vitamin D, and B12.
- Weight and Growth in Children: Ensure normal development.
- Symptom Resolution: Monitor improvement in gastrointestinal and systemic symptoms.
Patient Counselling Points
- Strict adherence to a gluten-free diet is essential, even if symptoms are mild or absent.
- Learn to read food labels and recognize hidden sources of gluten.
- Educate family members to prevent cross-contamination at home.
- Maintain follow-up appointments and regular tests to monitor health.
- Seek support groups for shared experiences and coping mechanisms.
Use in Children
- Focus on a balanced, gluten-free diet to support growth and development.
- Close monitoring for behavioural changes or irritability.
Use in Pregnancy
- Ensure adequate intake of iron, folic acid, and calcium to prevent complications.
Use in Elderly
- Monitor for osteoporosis and ensure dietary adherence to manage malabsorption-related issues.
FAQs About Coeliac Disease
Q1: What causes coeliac disease?
- Genetic predisposition and an autoimmune reaction to gluten.
Q2: Can coeliac disease be cured?
- No, but symptoms and complications can be managed with a lifelong gluten-free diet.
Q3: What foods should I avoid with coeliac disease?
- Wheat, barley, rye, and any products containing these grains.
Q4: How soon will I feel better after starting a gluten-free diet?
- Symptoms improve within weeks, but complete intestinal healing may take months to years.
Q5: Can I eat oats with coeliac disease?
- Only certified gluten-free oats, as regular oats are often contaminated with gluten.
Q6: What are the long-term risks of untreated coeliac disease?
- Malnutrition, osteoporosis, infertility, neurological issues, and certain cancers.
Q7: Is coeliac disease the same as gluten intolerance?
- No, gluten intolerance does not involve an autoimmune response or intestinal damage.
Q8: Can children outgrow coeliac disease?
- No, it is a lifelong condition requiring strict dietary management.
Q9: Can cross-contamination cause symptoms?
- Yes, even trace amounts of gluten can trigger symptoms and intestinal damage.
Q10: What is refractory coeliac disease?
- A rare condition where symptoms persist despite a strict gluten-free diet.
Q11: How is dermatitis herpetiformis related to coeliac disease?
- It is a skin manifestation of coeliac disease, treated with a gluten-free diet and medications like dapsone.
Q12: Should family members of a coeliac patient be tested?
- Yes, first-degree relatives have a higher risk and should be screened.
Q13: Is coeliac disease more common in women?
- Yes, it is slightly more common in women than men.
Q14: Can coeliac disease cause weight gain?
- Yes, especially after starting a gluten-free diet as nutrient absorption improves.
Q15: Are gluten-free products healthier for everyone?
- Not necessarily; gluten-free products can be high in sugar and fat. They are essential for those with coeliac disease.