Coeliac disease is a chronic autoimmune condition caused by a permanent intolerance to gluten. When a person with coeliac disease consumes foods containing gluten, the immune system is triggered to attack the lining of the small intestine, leading to damage and impaired absorption of nutrients.
Where is Gluten Found?
Gluten is found in:
- Wheat
- Barley
- Rye
- Processed foods containing wheat flour
Main Sources of Gluten:
Grains:
Wheat (including wheat, durum, spelt, kamut, einkorn), barley, rye, triticale
Bakery products:
Bread, cakes, biscuits, cookies, muffins, doughnuts, crackers, pretzels, pies, pasta, noodles, ramen, udon, pizza, tortillas
Cereals and breakfast foods:
Wheat- or barley-based cereals, granola bars, pancakes, waffles
Beverages:
Beer (made from barley), malt drinks, malt vinegar
Hidden Sources to Watch Out For (Always Read Labels):
Sauces and seasonings:
Soy sauce, ready-made salad dressings, gravy, soups, seasoning mixes
Processed foods:
Sausages, burgers, processed meats, seasoned frozen foods, flavoured crisps
Other ingredients:
Gluten may be used as a thickener or binding agent in many foods
Non-food products:
Some medicines, vitamins, dietary supplements, lip balm, toothpaste
Common Symptoms
Symptoms vary from person to person and may or may not involve the digestive system.
Gastrointestinal symptoms:
- Chronic diarrhoea / bloating
- Abdominal pain
- Weight loss
- Nausea
Other symptoms:
- Fatigue and low energy
- Anaemia (iron deficiency)
- Hair loss
- Low bone density / osteoporosis
- An itchy skin rash called dermatitis herpetiformis
- Infertility or recurrent miscarriage
- Brain fog and depression
Who Is at Risk of Coeliac Disease?
- People with a genetic predisposition or a first-degree relative with the condition
- People with other autoimmune diseases, such as type 1 diabetes or autoimmune thyroid disease
Treatment
Complete and lifelong avoidance of gluten (100%)
- Once gluten is eliminated, the intestinal lining can gradually heal
- Symptoms and nutritional deficiencies usually improve
Diagnosis
Blood Tests
Blood tests are used to detect antibodies associated with gluten intolerance (coeliac disease), including:
- Anti-tTG IgA (anti-tissue transglutaminase IgA) – screening test
- EMA-IgA (Endomysial Antibodies IgA) – confirmatory test
Genetic Testing
Genetic testing is performed to identify specific genes, including:
- HLA-DQ2
- HLA-DQ8
These genes are commonly found in individuals with coeliac disease.
Intestinal Biopsy (in Some Cases)
In certain cases, an upper endoscopy with a small-intestinal biopsy may be required to confirm the diagnosis.
Important Note:
For individuals who are still consuming gluten, gluten should not be eliminated before testing, as this may affect the accuracy of the results.
Summary
Coeliac disease is an autoimmune condition in which the immune system reacts to gluten in food, leading to inflammation and damage of the small intestine.
The main treatment is strict, lifelong avoidance of gluten. Patients need to adjust their lifestyle and dietary habits accordingly.
With proper management and adherence to a gluten-free diet, individuals with coeliac disease can maintain a good quality of life and prevent long-term complications.
References
- Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018).Coeliac disease. The Lancet, 391(10115), 70–81.
- Husby, S., Koletzko, S., Korponay-Szabó, I. R., et al. (2012). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease.Journal of Pediatric Gastroenterology and Nutrition, 54(1), 136–160.
- Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. American Journal of Gastroenterology, 108(5), 656–676.
- Hill, I. D., Dirks, M. H., Liptak, G. S., et al. (2005).Guideline for the diagnosis and treatment of celiac disease in children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 40(1), 1–19.
