Coeliac disease is a type of mal absorption where an allergy to the gluten protein of wheat, barley, rye and oats causes inflammation of the small intestine leading to a loss in height of the finger-like absorptive surface of the bowel so that it is no longer able to absorb food and nutrients properly.

Incidence/Age/Sex

The disease commonly presents in children under 2 years old within 6 months of starting a cereal diet but it can occur in young adults and even in the elderly when diarrhoea, mild anaemia and lethargy together with weight loss may be the presenting symptoms. The incidence is about 1 in 2000 to 8000 of the population and it is commoner in those of Irish origin. A quarter of patients will have a family history of the disease and the susceptability to it is inherited.

Coeliac disease signs and symptoms
In children there is a failure to grow. The motions become pale, very smelly and of large quantity and the abdomen becomes distended. Anaemia can occur.

In adults, the presentation is often with bulky stool, anaemia, vitamin deficiences particularly Vitamin D deficiency leading to a low serum calcium and Vitamin B12 and folate deficiency leading to a type of anaemia. A variant of coeliac disease is associated with itchy, red lesions on the skin and this is known as dermatitis herpetiformis.

Complications of the disorder

Anaemia and Vitamin D deficiency may occur secondarily to the disorder. If after many years it can predispose to lymphoma of the small bowel.

Tests
Blood tests to look for two antibodies known as anti gliadin and anti endomesial antibodies may point the way to the diagnosis. The most usual way to make the diagnosis is with a duodenal or jejunal biopsy taken at endoscopy. This will show stunted villi in the small bowel together with lots of inflammatory cells in the bowel lining.

Coeliac disease treatment

Treatment involves exclusion of wheat and wheat products from the diet. As well as wheat, rye, oats and barley must be excluded. There is a Coeliac Disease Society which is very helpful in providing recipes and lists of products which are gluten-free. Vitamin supplements are some times required in addition to a gluten-free diet. Where a gluten-free diet is strictly adhered to the risk of lymphoma is decreased. A repeat endoscopy is usually recommended to check that the small bowel lining has gone back to normal after a gluten-free diet has been adhered to for at least 3 months.