People with the coeliac (pronounced see-lee-ak) disease cannot tolerate gluten, a protein found in wheat, rye, and barley (and in some everyday medicines, vitamins, and lipbalms). This digestive disease damages the small intestine and interferes with absorption of nutrients from food. When people with the coeliac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi – the tiny, finger-like protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person will become malnourished, no matter how much food he eats!
Children with Coeliac Disease
Symptoms of coeliac disease may occur in the digestive system or in other parts of the body, and vary from person to person.
These digestive symptoms are more common in infants and young children:
- Abdominal bloating and pain.
- Chronic diarrhoea.
- Pale, foul-smelling, or fatty stool.
- Weight loss.
Irritability is another common symptom in children. Malabsorption of nutrients during the formative years when nutrition is critical to a child’s normal growth and development, can result in other problems, such as failure-to-thrive in infants, delayed growth and stunted stature, delayed puberty, and dental enamel defects of permanent teeth.
Coeliac Disease in Adults
Adults are less likely to have digestive symptoms, and may instead have one or more of the following:
- Unexplained iron-deficiency anaemia.
- Bone or joint pain.
- Bone loss or osteoporosis.
- Depression or anxiety.
- Tingling numbness in hands and feet.
- Missed menstrual periods.
- Infertility or recurrent miscarriage.
- Canker sores inside the mouth.
- Itchy skin rash called dermatitis herpetiformis.
People with coeliac disease may have no symptoms, but can still develop complications of the disease over time. Long-term complications include malnutrition—which can lead to anaemia, osteoporosis, and miscarriage, among other problems—liver disease, and cancer of the intestine.
People with coeliac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues:
- Type 1 diabetes.
- Autoimmune thyroid disease.
- Autoimmune liver disease.
- Rheumatoid arthritis.
- Addison’s disease, a condition in which the glands that produce critical hormones are damaged.
- Sjögren’s syndrome, where the glands that produce tears and saliva are destroyed.
Detecting the coeliac disease can be difficult, because some of its symptoms are similar to those of other diseases.The coeliac disease has long been underdiagnosed or misdiagnosed, because it is often confused with:
- Irritable bowel syndrome.
- Iron-deficiency anaemia caused by menstrual blood loss.
- Inflammatory bowel disease.
- Diverticulitis – inflammation of a diverticulum in the digestive tract, especially the colon.
- Intestinal infections.
- Chronic fatigue syndrome.
People with coeliac disease have higher-than-normal levels of certain autoantibodies —proteins that react against the body’s own cells or tissues — in their blood.
- To diagnose coeliac disease, doctors will test blood for high levels of the anti-tissue TransGlutaminase Antibodies (tTGA) or anti-EndoMysium Antibodies (EMA).
- If the test results are negative but coeliac disease is still suspected, additional blood tests may be needed.
- If blood tests and symptoms suggest coeliac disease, a biopsy of the small intestine is performed to confirm the diagnosis.
- During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi.
Wheat is the Matter
Doctors may ask a newly diagnosed patient to work with a dietician on a gluten-free diet plan, as that is the only treatment for coeliac disease. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage.
- Improvement begins within days of starting the diet. The small intestine usually heals in three to six months in children, but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.
- To stay well, people with coeliac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine! The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.
- Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory coeliac disease, have severely damaged intestines that cannot heal.