What is coeliac disease?
– It is a condition in which the lining of the small intestine is damaged by gluten. Gluten is a protein found in rye, wheat, barley and possible oats.
– This damage causes foods to not be absorbed properly by the small intestine and so before diagnosis there is weight loss and possibly malnutrition.
– Treatment is a gluten free diet.
Gluten is a protein found in wheat, barley and rye
– It is prevalent in the UK although estimates of incidence vary from 1 in 1000 to 1 in 300
– It can be diagnosed at any age but mostly it is finally diagnosed in adulthood usually in the 30-45 age group.
– Many other cases may remain undiagnosed or may be falsely diagnosed as irritable bowel syndrome and only a third of cases are ever diagnosed as coeliac disease and treated with a gluten free diet.
– Certain groups are at greater risk of developing coeliac disease – people with Type 1 diabetes, Downs syndrome, thyroid disease and osteoporosis.
Coeliac disease is a common digestive condition where a person has an adverse reaction to gluten
Eating foods containing gluten can trigger a range of symptoms, such as:
diarrhoea – which may be particularly unpleasant smelling bloating and flatulence (passing wind) abdominal pain weight loss feeling tired all the time – as a result of malnutrition (not getting enough nutrients from food) children not growing at the expected rate
Symptoms can range from mild to severe.
Research in Finland looked at 300 people with coeliac disease and showed that:
– only 24% of 300 people with coeliac disease had classic symptoms
– 36% had minor symptoms
– 27% were diagnosed with associated diseases and 13% by chance.
– 51% had another autoimmune disease with 16% of this group having diabetes.
The symptoms of coeliac disease
Coeliac disease can cause people to be acutely and severely ill with weight loss, vomiting and diarrhoea or they may be chronic and seem unimportant, such as tiredness, lethargy and breathlessness but usually the symptoms are somewhere between the two. However, some people are diagnosed without having any symptoms.
Adults may have a history of abdominal discomfort or they may develop coeliac disease at any time. Anaemia, mouth ulcers and weight loss are common signs.
Babies are fit and well until the introduction solid foods that contain gluten when the baby would become pale, bulky, offensive-smelling stools and be lethargic and miserable. All these symptoms could apply to other conditions so it is important that you do not assume that you have coeliac disease but seek medical help.
Coeliac disease is nearly always diagnosed by a gastroenterologist. Until recently coeliac disease could only be detected after years of symptoms an intestinal biopsy. The new test measures antibodies in the blood to gluten and gliaden in the diet and damaged endomysial muscle in the bowel. The anti-gliaden antibodies disappear with a gluten free diet but the endomysial antibodies persist in all people with untreated and treated coeliac disease and so it is an excellent screening test although not 100% accurate.
Diabetes and coeliac disease
Both diabetes and coeliac disease are autoimmune diseases and there are increasing amounts of research to show that there is a link between the two both in adults, children and adolescents. Increasingly there are views that more attention should be given to this link and that tests for coeliac disease should be routinely carried out in both adults and children with diabetes [ref 1].
Coeliac disease maybe the cause of vague abdominal symptoms and may cause hypoglycaemia due to impaired carbohydrate absorption in the gut. A further study carried out in Oxford [ref 1] looked at 167 children and young people with diabetes. Antibody tests for coeliac disease were carried out and eleven [6.6%] were antibody positive and of the eleven:
– only 1 had coeliac disease symptoms
– 4 had a history of gastro-intestinal problems but not severe enough to seek medical advice
– 6 showed no symptoms at all.
Nine of this group of eleven agreed to a biopsy and 8 of them had typical coeliac features of the small bowel. All were treated with a gluten-free diet and monitored for up to 2 years. They were symptom free. Those showing no symptoms at all before the study reported no change in their well-being and follow up biopsies showed normal appearances of the small bowel suggesting that treatment had been effective.
The authors point out that screening for coeliac disease in these youngsters with diabetes showed a high percentage had coeliac disease but the majority of them did not show the classic symptoms. At present it is not known whether treating symptomless people will be of benefit considering the riggers of the voeliac diet and whether or not they are at greater or lesser risk of the long-term complications of coeliac disease.
Ref 1 Coeliac Disease in Children and Adolescents with IDDM. D.B.Dunger et al. Diab Med, Vol 15: 38-44