Coeliac disease is a condition where the small intestine is sensitive to gluten - a protein substance contained in wheat, rye and barley. Gluten is the compound in flour that makes dough 'sticky'. Sensitivity to it flattens the finger like projections of the intestine so that the intestine has less area to absorb food.
Coeliac disease is one of the autoimmune conditions in which the immune system of the body reacts against its own tissues. It is very common and about one person in a hundred of the population will have it. Many research workers are looking into the genes that may be responsible. There is a marker called HLA DQ2 that is most commonly associated with the condition.
It is treated with a gluten-free diet. Most affected people lead a normal life.
How does it affect people?
Some patients may not have any symptoms but the disease may be suspected because of a mild abnormality in a blood test, such as anaemia. Most affected people have mild symptoms with a feeling of tiredness, mouth ulcers and diarrhoea. Other patients may have obvious symptoms such as diarrhoea, weight loss, tiredness, and mouth ulcers.
How is the diagnosis made?
There is now a very sensitive blood test that measures the antibodies that the body makes against intestinal constituents. These are called ‘tissue transglutaminase (tTG) antibody and endomysial (EM) antibody. Blood levels of immunoglobulin A are measured because the tTG and EMA tests depend on it.
If these tests are positive, the doctor may also suggest that you have an endoscopy to take a biopsy of the small bowel to look at under the microscope. A biopsy is important because the treatment of coeliac disease is a life-long gluten free diet, which should not be lightly undertaken.
A blood count, iron and vitamin levels and thyroid tests are also commonly done. Anaemia is quite common with coeliac disease as the intestines do not absorb iron or vitamin B12 and folic acid very well. Thyroid disease is also an autoimmune disease and is commonly associated.
What is the treatment?
The only treatment at present is a ‘gluten free’ diet that excludes wheat, rye or barley from your food. So bread, biscuits, cakes, gravies thickened with flour or indeed anything containing wheat, rye or barley are off the menu, for life. Some people also react to oats, probably because oats may be contaminated by wheat. Corn flour and rice are fine.
A gluten-free diet can be quite restricting, particularly when you go out to eat. Gluten-free bread, flour, pasta, biscuits and other things are available on prescription. Gluten-free items in the shops will have the ‘crossed grain’ symbol of the Coeliac Society on the labels.
How can I find out about the gluten free diet?
You will need to see a specialist dietician who will help you adjust to the new diet. You can also join the Coeliac Society. This is a society of people affected by Coeliac Disease. It gives very helpful advice on foods, menus, cooking and foods to avoid www.coeliac.org.uk
Will my children be affected?
Possibly; there is an increased frequency of the condition occurring in first degree relatives, probably because the disease is at least in part genetic. A baby is usually fine until it is weaned onto flour containing gluten. The baby may then develop symptoms of irritability, failure to thrive and diarrhoea.
Can I grow out of having coeliac disease?
No. Once you have been diagnosed properly as an adult, you will have it for life. You will need to keep to a strict gluten free diet. Transient gluten intolerance can occur in children, but not in adults.
What will happen if I don’t stick to the diet?
You are likely to get your symptoms back again. You may also be liable to get complications such as osteoporosis. There is a suspicion that some cancers are more common in untreated coeliac disease. Doctors therefore recommend that you keep as strictly to the diet as possible.
How often do I have to see the doctor after my diagnosis is made?
If you are well on the diet, your doctor may suggest seeing you once a year to check with some blood tests.