What is Coeliac / Celiac Disease?

Do you want to know how to cure your celiac disease? Coeliac disease ( spelled celiac disease in North America) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. The common term for the disease is gluten intolerance.

Symptoms of coeliac disease include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. A growing portion of diagnoses are being made in asymptomatic persons as a result of increased screening.

Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other cultivars such as barley and rye). Upon exposure to gliadin, and certain other prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet.

While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.

Coeliac disease has been linked with a number of conditions. In many cases, it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.

• IgA deficiency is present in 2% of patients with coeliac disease, and in turn, this condition features a tenfold increased risk of coeliac disease. Other features of this condition are an increased risk of infections and autoimmune disease.
  
  
• Dermatitis herpetiformis; this itchy cutaneous condition has been linked to a transglutaminase enzyme in the skin, features small-bowel changes identical to those in coeliac disease and occurs more often (in 2%) in patients with coeliac disease.
  
  
• Neurological associations: epilepsy, ataxia (coordination problems), myelopathy, peripheral neuropathy, and schizophrenia have all been linked with coeliac disease, but the strength of these associations and the causality are still subject to debate.
  
  
• Growth failure and/or pubertal delay in later childhood can occur even without obvious bowel symptoms or severe malnutrition. Evaluation of growth failure often includes coeliac screening.
  
  
• Miscarriage and infertility.
  
  
• Hyposplenism (a small and underactive spleen)—it is unclear whether this actually increases infection risk in the same way as in other people without a functioning spleen.
  
  
• Other autoimmune disorders: diabetes mellitus type 1, autoimmune thyroiditis, primary biliary cirrhosis, and microscopic colitis.
  
  
• Death —Individuals with celiac disease are at a 40% increased risk of death. This risk increase has been seen in both adults and children. Risk increases have been shown for death from cancer and in cardiovascular disease.

At present, the only effective treatment is a life-long gluten-free diet.

No medication exists that will prevent damage or prevent the body from attacking the gut when gluten is present. Strict adherence to the diet allows the intestines to heal, leading to resolution of all symptoms in most cases and, depending on how soon the diet is begun, can also eliminate the heightened risk of osteoporosis and intestinal cancer that can arise from coeliac disease.

Dietician input is generally requested to ensure the patient is aware which foods contain gluten, which foods are safe, and how to have a balanced diet despite the limitations. In many countries, gluten-free products are available on prescription and may be reimbursed by health insurance plans.

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